Naturalistic psychedelic experiences and gender-based self-acceptance in transgender and gender-expansive people.

Background: While psychedelic medicines have increasingly been studied for their utility as an adjunct to psychotherapy, transgender and gender-expansive (TGE) individuals have rarely been the focus of psychedelic research. This study examines TGE people's naturalistic, non-clinical psychedelic experiences to explore how TGE people use psychedelics and how they describe relationships between psychedelic use and their gender journey. Methods: Informed by Black feminist epistemological methodology, we conducted a qualitative analysis of 20 in-depth, hour-long, semi-structured Zoom interviews of TGE individuals who previously responded to a quantitative survey about their psychedelic experiences. The interviews explored participant narratives about their naturalistic psychedelic use and how it may have informed their gender journey. Results: We found three main themes. First, participants described how their mindset and the setting of their psychedelic experience influenced the quality of that experience. Second, many participants reported that naturalistic psychedelic experiences facilitated increased self-acceptance of their gender identity via increased self-compassion and an expanded concept of gender. Third, some participants described various experiences related to their mental health during and after naturalistic psychedelic use, including challenging experiences such as gender dysphoria and mental health benefits such as gender euphoria. Discussion: These observations may help mental health clinicians better support TGE people who use psychedelics. Clinicians should consider encouraging the preparation of a gender-affirming setting and mindset before psychedelic use and supporting potential shifts in gender understanding and self-acceptance after psychedelic use. Tailored educational resources for TGE people who engage with psychedelic substances in naturalistic settings are needed.