Transgender and gender-expansive (TGE) people use psychedelics in naturalistic, non-clinical settings to explore and affirm their gender identity. Interviews with 20 TGE individuals revealed three main themes: the mindset and physical setting of a psychedelic experience shape its quality; such experiences often increase self-acceptance of gender identity through greater self-compassion and a broader concept of gender; and participants reported both challenging effects like gender dysphoria and benefits like gender euphoria. The findings suggest clinicians should help TGE clients prepare a gender-affirming setting before psychedelic use and support shifts in gender understanding afterward.
Transgender and gender-expansive individuals, particularly those who are Black, Indigenous, and People of Color, use psychedelics to heal from identity-based traumas such as racism and transphobia. Interviews with 20 participants revealed awareness of the Indigenous roots of psychedelic plant medicine and concerns that ongoing medicalization of psychedelics, shaped by colonization and structural racism, reproduces inequities in access and experience. Some participants opposed medicalization, linking it to racist and colonial dynamics. The findings suggest that culturally humble and ethically responsible models of psychedelic-assisted therapy are needed to promote health equity for transgender and gender-expansive people of color.