Abstract
This study investigated subjective psychedelic experiences in the global LGBTQIA+ population. Using validated measures of acute psychedelic effects, psychological flexibility, gender and sexual identity attitudes, adverse experiences, and mental health, we examined self-reported changes in identity and mental health outcomes following psychedelic use. A total of 346 individuals completed the survey. The sample was predominantly White (78.6%) with a mean age of 31.7 years. Over half were assigned female at birth (57.8%), and participants identified across diverse gender categories: women (28.9%), genderqueer (19.5%), nonbinary (17.6%), and men (15.9%). Participants reported lifetime use of classical psychedelics (M = 22.8) and MDMA (M = 11.3). Most (77.2%) endorsed the therapeutic potential of psychedelics for gender dysphoria, and 65.3% reported changes in gender identity attitudes post-experience. Retrospective self-reports indicated significant changes in sexual identity and commitment, with effects ranging from small to large. Mental health improvements included reductions in traumatic stress (d = 1.051), depression (d = 0.756), and anxiety (d = 0.859), and increased psychological flexibility (d = 0.996). Canonical correlation analysis identified a significant relationship (Rc = 0.49, p = .001) between the intensity of acute psychedelic effect and increases in self-acceptance and sexual identity exploration. These findings suggest that psychedelic experiences may positively impact mental health and facilitate identity exploration in LGBTQIA+ individuals. This study offers preliminary support for further research into the therapeutic potential of psychedelics within marginalized communities.
Keywords: Psychedelics, LGBTQIA+, identity, mental health, naturalistic use, survey study
Introduction
Background
Gender and sexual minorities (GSM), including those who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic/agender (LGBTQIA or LGBTQ+), make up a significant and growing portion of the population, with recent studies estimating between 5.5–7.2% of adults in the United States identify as GSM (Flores and Conron 2023; Hasler 2023; Jones 2022, 2023). For individuals in these communities, gender and sexual identity are central to their sense of self and relationships with others (Bauerband and Galupo 2014; Worthington et al. 2008). However, rigid societal norms around gender and sexuality often lead to stigma, discrimination, and violence against GSM individuals (Barker and Iantaffi 2017; Littlejohn, Poteat, and Beyrer 2019). This societal marginalization has profound impacts on the mental health of GSM individuals, creating a substantial public health concern.
Mental health disparities in GSM populations
Despite increasing social acceptance of GSM individuals in many parts of the world, significant mental health disparities remain. GSM individuals are at a disproportionately high risk of experiencing mental health conditions such as depression, post-traumatic stress disorder (PTSD), substance use disorders, and suicidal ideation (Hanshaw et al. 2024; Hatzenbuehler and Pachankis 2016). Gender minority individuals, in particular, are four times more likely than their cisgender counterparts to experience mental health challenges, while sexual minorities are twice as likely as heterosexual individuals to suffer from similar conditions (Medley et al. 2016; Moagi et al. 2021; Wanta et al. 2019). Contributing factors include adverse childhood experiences, social stigmatization, and barriers to accessing affirming healthcare (McDonald 2018; Moagi et al. 2021). The lack of adequately trained mental health professionals further compounds the problem, leaving many GSM individuals without effective, evidence-based treatments tailored to their specific needs (Singh and Shelton 2011; Skinta, Leonard-Curtin, and Pachankis 2016).
The potential of psychedelics in mental health treatment
Recent advances in psychopharmacology have sparked interest in the therapeutic potential of classical psychedelics, including lysergic acid diethylamide (LSD), mescaline, psilocybin, and N,N-dimethyltryptamine (DMT). These substances are known to induce profound changes in mood, perception, and cognition, which may underlie their therapeutic benefits (Barrett et al. 2020; Carhart-Harris et al. 2012; Nichols 2004). Research has shown that psychedelics can facilitate neural plasticity and new perspectives, offering promising outcomes in the treatment of psychiatric conditions such as depression, anxiety, PTSD, and substance use disorders (Carhart-Harris et al. 2016; Davis et al. 2021; Gregorio et al. 2021).
Beyond their general therapeutic applications, psychedelics may hold unique potential for addressing mental health disparities among GSM individuals, whose psychological distress is often linked to minority stress, chronic shame, and identity-related trauma. Psychedelic-assisted therapy (PAT) has been proposed as a means to help GSM individuals process experiences of social stigma and internalized oppression, with research suggesting that these substances may facilitate emotional processing, self-acceptance, and resilience (Hanshaw et al. 2024). Furthermore, the non-ordinary states induced by psychedelics may allow for a reappraisal of entrenched negative self-perceptions, particularly for those who have experienced chronic shame due to societal marginalization (Carlisle et al. 2023).
Although preliminary evidence supports the potential of PAT among GSM people, the intersectional barriers that GSM individuals face in accessing mental health care raise critical considerations for PAT implementation. As Ching (2020) highlights, ensuring that PAT is culturally responsive and inclusive requires recognizing the distinct needs of GSM populations and training therapists to navigate identity-related complexities within treatment settings. Although the broader psychedelic research field has begun to explore these issues, there remains a lack of systematic investigation into how GSM individuals uniquely engage with psychedelics, both in therapeutic and naturalistic settings. Expanding research in this area is essential to ensuring that psychedelic therapies are developed in ways that equitably serve diverse populations.
Expanding understanding through naturalistic research
While controlled clinical trials provide valuable insights, naturalistic studies offer a complementary perspective on how psychedelics are used and experienced in real-world settings. Cross-sectional surveys have consistently demonstrated positive mental health outcomes associated with psychedelic use, including reductions in psychological distress and suicidality (Hendricks et al. 2015; Raison et al. 2022). Importantly, these studies highlight the broader social and cultural contexts in which psychedelic experiences occur, which may be particularly relevant for GSM individuals facing identity-related stressors. Although anecdotal reports suggest that psychedelics may help GSM individuals gain clarity about their identities and process emotions related to discrimination and trauma (Ching 2020; Hodges 2020), more systematic research is needed to investigate these effects (Breeksema et al. 2020).
The current study
Despite increasing interest in psychedelics as a tool for mental health, there remains a critical gap in the literature concerning naturalistic GSM psychedelic use. To date, no study has systematically explored the self-reported experiences of GSM adults who have used psychedelics or MDMA in relation to their identity development, psychological functioning, and overall well-being. The present study aims to fill this gap by: (1) investigating the characteristics of psychedelic use among GSM individuals, (2) exploring the variety of acute subjective effects they report, (3) examining changes in gender and/or sexual identity following a memorable psychedelic experience, and (4) assessing shifts in mental health functioning related to these experiences.
Methods
Overview
This study consisted of an online survey hosted on a secure website (www.qualtrics.com) and data collection took place between August and December, 2022. Using a cross-sectional, observational design, we included validated measures of childhood and lifetime adverse experiences, acute psychedelic experience, depression, anxiety, PTSD, psychological flexibility, social support, and attitudes toward gender identity and sexual identity. Respondents completed an online survey with a specific psychedelic experience in mind as the reference experience. The study protocol was reviewed and approved by the Institutional Review Board (IRB) at The Ohio State University.
Respondents
Inclusion/exclusion criteria
Respondents were required to meet the following criteria: (a) 18 years or older, (b) Fluent in English, (c) Have taken a psychedelic 30 days ago or more, (d) Identify as LGBTQ.
Recruitment
Interested individuals were referred to the survey website through several mechanisms, primarily via the Center for Psychedelic Drug Research & Education website (www.cpdre.org), e-mail lists, snowball sampling, websites (e.g., www.dancesafe.org, www.bluelight.org, among others), and social media (i.e., Facebook, Instagram). Advertisements for the survey aimed to attract individuals who believed they had a memorable experience with a psychedelic or MDMA and identified as part of the LGBTQIA+ community. Additionally, recruitment was done through various subreddit forums; Discord channels; and psychedelic association e-mail lists.
Procedures
Once on the survey website, individuals were presented with an electronic copy of our informed consent document, which provided more detail about the survey procedures and the inclusion/exclusion criteria. Individuals indicating that they met the inclusion criteria, understood the study requirements, and were willing to voluntarily participate were directed to the survey. Upon completing and exiting the survey, respondents were asked whether they would like to be entered for a chance to win one of 15 $100 gift certificates, 300 $20 gift certificates, or 600 $10 gift certificates. Respondents were also able to opt into being contacted about future opportunities to participate in additional research.
Respondent characteristics and data quality checks
A total of 9351 raw combined cases were initially obtained. Of these, 8349 consented to participate, and 7060 cases were identified as never having completed the survey before. From these, 7038 were aged 18 or older, 6985 were fluent in English, and 6858 had taken a psychedelic 30 days or more prior. Among these, 6767 identified as LGBTQ+, and 5127 completed 95% or more of the survey. Further quality checks included verifying age consistency (4562 filled out the age check, and 4145 had matching age checks), honesty checks (3995 passed), and validation of drug use (3628 reported using a valid drug such as LSD, Psilocybin, Mescaline, DMT, Ayahuasca, Changa, 5-MeO-DMT, MDMA, 2C-B, or DOM). A reCAPTCHA score above .5 was required, leaving 2267 valid cases. Additionally, responses taking less than 30 minutes were eliminated (to reduce bias of fast responding), reducing the sample by 894 cases, and attention checks in the MEQ30 led to the removal of 1546 cases. Cases with fraudulent e-mails were cross-checked with qualitative responses, resulting in the removal of 456 cases, and 367 responses indicating poor or invalid responding were excluded. After combining datasets and checking for inconsistencies, 1 case was removed for reporting mescaline taken intramuscularly, resulting in a final combined master dataset of 346 cases.
Measures
Demographics
Demographics included age, race, ethnicity, sex, primary gender, primary sexual orientation, age of first use of psychedelic substances, substance use history, opinions about psychedelic-assisted therapy, whether a psychedelic experience had an impact on gender identity, sexual identity, or both, and history of mental health condition diagnosis.
Adverse childhood experiences survey (ACES)
A 10-item scale assessing childhood exposure to adversity, including abuse, neglect, and household dysfunction, with higher scores indicating greater adversity (Felitti et al. 1998; Herzog and Schmahl 2018).
Specific psychedelic experience
This 23-item measure was designed for this study to capture information about mental health conditions before and after a specific experience with a psychedelic or MDMA, as well as details pertaining to the specific psychedelic experience (e.g., substance used, route of administration, and the experience’s effect on respondents’ relationship to sexual trauma or gender/sexual minority trauma).
Mystical experiences questionnaire (MEQ-30)
A 30-item scale assessing the intensity of mystical experiences following psychedelic use, including unity, joy, and timelessness. The MEQ-30 has been extensively validated and is widely used in research to link mystical experiences with lasting psychological benefits, including increased openness and well-being (Barrett, Johnson, and Griffiths 2015; Griffiths et al. 2006, 2008, 2016; Maclean et al. 2012).
Persisting effects questionnaire (PEQ)
This 15-item measure assesses the long-term impact of psychedelic experiences. Participants rate the degree to which their experience influenced personal well-being, life satisfaction, purpose, and relationships. The PEQ has been linked to enduring positive changes following psychedelic use (Griffiths et al. 2011).
Emotional breakthrough inventory (EBI)
The EBI is a 6-item measure designed to assess the degree of emotional breakthrough during psychedelic experiences. It captures emotional release and processing, which are linked to therapeutic outcomes like reduced distress and increased emotional clarity (Roseman et al. 2019).
Challenging experiences questionnaire (CEQ)
This 26-item scale evaluates distressing or difficult experiences during or after psychedelic use, such as fear, paranoia, and grief. The CEQ helps quantify the intensity and impact of negative experiences, which are important for understanding the full range of psychedelic effects (Barrett et al. 2016).
Ego dissolution inventory (EDI)
The EDI is an 8-item measure assessing the degree to which individuals experience ego dissolution – feeling a loss of self-identity and merging with surroundings – during psychedelic use. Ego dissolution is often linked to therapeutic and transformative outcomes in psychedelic research (Nour et al. 2016).
Psychological insight questionnaire (PIQ)
This 23-item scale evaluates the extent of psychological insight gained during a psychedelic experience, focusing on insights related to emotions, beliefs, and relationships. The PIQ is associated with positive therapeutic outcomes, such as improved emotional well-being and behavioral change (Davis et al. 2021).
Transgender congruence scale (TCS)
The TCS is a 12-item measure assessing the alignment between an individual’s internal gender identity and their external appearance. It includes self-acceptance and comfort with one’s gender expression and is widely used to explore the mental health and well-being of transgender individuals (Kozee, Tylka, and Bauerband 2012).
Gender identity reflection and rumination scale (GIRRS)
The GIRRS is a 15-item scale designed to measure cognitive processes related to gender identity, including self-reflection and rumination. This measure assesses how individuals process their gender identity and how these thought patterns impact their emotional and mental health (Bauerband and Galupo 2014).
Measure of sexual identity exploration and commitment (MoSIEC)
This 22-item scale assesses sexual identity development across four dimensions: Commitment, Exploration, Identity Uncertainty, and Integration. It is commonly used to understand how individuals explore and commit to their sexual identity and how this affects their overall self-concept (Worthington et al. 2008).
The self-acceptance of sexuality inventory (SASI)
The SASI is a 10-item measure designed to assess self-acceptance related to one’s sexual identity. It captures levels of comfort with one’s sexuality, as well as difficulties with self-acceptance, offering insights into how individuals feel about their sexual orientation (Camp, Vitoratou, and Rimes 2022).
Data analysis
Regarding aim 1, we used descriptive analyses and frequency distributions to explore the demographic characteristics (age, race, ethnicity, assigned sex at birth, primary gender identity, primary sexual orientation, age of first psychedelic use, lifetime uses of psychedelics, lifetime uses of MDMA, perceived effect of psychedelics on attitudes toward gender/sexual identity, and history of mental health diagnoses) of GSM who used psychedelics in non-clinical settings.
Regarding aim 2, we conducted descriptive analyses to explore the variety of acute subjective effects experienced by GSM. This included measures of mystical experience (MEQ-30), emotional breakthrough (EBI), psychological insight (PIQ), ego dissolution (EDI), and challenging experiences (CEQ) during the psychedelic use.
Regarding aim 3, we examined the association between self-reported acute psychedelic effects and changes in gender and sexual identity from before to after a meaningful psychedelic experience. T-tests were conducted for the shift scores of all gender identity and sexual identity measures. These included the Transgender Congruence Scale (TCS), Gender Identity Reflection and Rumination Scale (GIRRS), Measure of Sexual Identity Exploration and Commitment (MoSIEC) subscales (Exploration, Commitment, Uncertainty, and Synthesis), and Self-Acceptance of Sexuality Inventory (SASI) subscales (Acceptance and Difficulties with Acceptance).
Regarding aim 4, we assessed whether self-reported acute psychedelic effects are related to shifts in mental health functioning. We used t-tests to compare self-reported changes in mental health symptoms (GAD-7 for anxiety, PHQ-9 for depression, and PCPTSD-5 for PTSD) and psychological flexibility (MPFI Flexibility and Inflexibility subscales) before and after the psychedelic experience. A canonical correlation analysis was conducted between acute psychedelic experience measures (MEQ, EBI, PIQ, CEQ) and identity-related outcome measures (TCS, MOSIEC, and SASI) to explore the associations between acute psychedelic experiences and overall identity-related outcomes.
We used alpha cutoffs of p < .05 to determine statistical significance.
Results
Respondent characteristics
A total of 346 individuals completed the survey. As shown in Table 1, the sample was primarily comprised of White people (78.6%) in their early 30s (Mage = 31.7, SD = 9.5). Over half of the sample was assigned female at birth (57.8%). People in this sample identified as women (28.9%), genderqueer (19.5%), nonbinary (17.6%), and men (15.9%). We did not collect nationality data. Prior psychiatric diagnoses reported by survey respondents included anxiety (45.7%), depression (48.3%), PTSD (27.2%), ADHD (25.2%), gender dysphoria (14.5%), social anxiety (16.8%), and psychotic disorder (2.3%). Additionally, survey respondents reported experiencing an average of 4 adverse childhood experiences (ACES) (MACES = 4.03, SD = 2.48; range 0–10; scores above 3 indicate higher risk for stress-related health outcomes).
Table 1.
Demographic characteristics and psychiatric history of the full sample.
| Characteristic | Overall sample (N = 346) M(SD) or % |
|---|---|
| Age | 31.66 (9.5) |
| Race (n = 346) | |
| American Indian or Alaska Native | 3.5% |
| Asian | 10.4% |
| Black or African American | 10.1% |
| Native Hawaiian or Other Pacific Islander | 0.9% |
| White | 78.6% |
| Write-in | 6.4% |
| Hispanic or Latinx | 19.1% |
| Assigned Sex at birth (n = 346) | |
| Male | 42.2% |
| Female | 57.8% |
| Primary gender identity (n = 346) | |
| Man | 15.9% |
| Woman | 28.9% |
| Nonbinary | 17.6% |
| Genderfluid | 3.5% |
| Gender nonconforming | 2% |
| Genderqueer | 18.5% |
| Agender | 1.7% |
| Transgender man | 1.4% |
| Transgender woman | 4.3% |
| Two-spirit | 1.2% |
| Something else | 3.8% |
| Transfemme | 0.6% |
| Transmasc | 0.6% |
| Primary sexual orientation | |
| Heterosexual | 1.2% |
| Homosexual | 19.1% |
| Bisexual | 24% |
| Pansexual | 15.6% |
| Asexual | 2.9% |
| Something else | 3.2% |
| Queer | 34.1% |
| Psychiatric history | |
| Anxiety | 45.7% |
| Depression | 48.3% |
| PTSD | 27.2% |
| ADHD | 25.1% |
| OCD | 6.1% |
| Autism | 10.1% |
| Bipolar disorder | 8.1% |
| Gender dysphoria | 14.5% |
| Alcohol use disorder | 4.3% |
| Drug use disorder | 4.9% |
| Social anxiety | 16.8% |
| Psychotic disorder (e.g., psychosis, schizophrenia, delusional disorder) | 2.3% |
| Borderline personality disorder | 4% |
| Adverse Childhood Experience Survey (ACES) ^ | 4.03(2.48) |
Score range for each measure: ACES survey (10-items; score range 0–10; scores above 3 indicate higher risk for stress related health outcomes)
Psychedelic use history and acute effects
As shown in Table 2, survey respondents reported lifetime use of classical psychedelics (M = 22.8, SD = 28.02) and MDMA (M = 11.26, SD = 20.57), and that they consumed a moderately high (46.7%) or high dose (17.2%) during their most memorable psychedelic experience. Of the classical psychedelics endorsed, LSD was the most common (45%), followed by psilocybin (38%). Over three-quarters (77.2%) of all survey respondents reported believing that PAT could be used to help individuals suffering from issues related to gender dysphoria, and 65.3% reported that taking psychedelics had an effect on the evolution of attitudes toward their gender identity. The average respondent age at the time of their most memorable experience was 26 (Mage = 26.05, SD = 7.96), with an average duration since the experience being 4.5 years (Mtime = 4.51, SD = 2.11). On measures of acute drug effect, respondent scores indicated middle- to upper-middle range for mystical experience (scaled “0–none/not at all” to “5–extreme/more than any other time in my life and stronger than 4;” M = 3.33, SD = 2.48), emotional breakthrough (range from “0–no, not at all” to “5–Extremely, more than ever before;” MEBI = 3.50, SD = 1.21), psychological insight (range from “0–no, not at all” to “5–extremely, more than ever before in my life;” MPIQ = 3.02, SD = 1.08), and ego dissolution (range from “0—None, none at all” to “5—Extreme (more than ever before in my life);” MEDI = 3.04, SD = 1.18). Scores measuring challenging acute experiences indicated average respondents scored less than 1 on a scale of “0–none at all” to “5–extreme, more than ever before in my life” (MCEQ = 0.30, SD = 0.25).
Table 2.
Psychedelic use history, perceptions about psychedelic use and impact on gender and sexual identity, and self-reported acute psychedelic effects in the sample.
| Characteristic | Mean(SD) or % |
|---|---|
| Psychedelic Use | |
| Lifetime classic psychedelic use | 22.8(28.02) |
| Lifetime MDMA use | 11.3(20.57) |
| Age at time of most memorable experience | 26.1(7.96) |
| Time in years since most memorable experience | 4.5(2.11) |
| Acute effects measures | |
| Mystical Experience Questionnaire (MEQ)^ | 3.3(0.87) |
| Emotional Breakthrough Inventory Total (EBI)^ | 3.5(1.21) |
| Psychological Insight Questionnaire Mean (PIQ)^ | 3.0(1.08) |
| Ego Dissolution Inventory Total (EDI)^^ | 3.0(1.18) |
| Challenging Experience Questionnaire Total (CEQ)^^^ | 0.3(0.25) |
| Type of psychedelic used in most memorable experience | |
| LSD | 45.0% |
| Psilocybin | 38.0% |
| Mescalin | 1.0% |
| DMT | 3.0% |
| Ayahuasca | 4.0% |
| 5-MeO-DMT | 0.3% |
| MDMA | 9.0% |
| 2C-B | 0.3% |
| Self-reported dose strength | |
| Low | 3.9% |
| Moderate | 32.3% |
| Moderately High | 46.7% |
| High | 17.2% |
| How was the psychedelic administered? | |
| Smoked or vaporized | 4.6% |
| Oral (e.g., swallowed) | 95.4% |
| Do you think psychedelic-assisted therapy could be used as a modality to help individuals suffering with issues related to gender dysphoria? | |
| No | 5.8% |
| Yes | 77.2% |
| Not Sure | 17.1% |
| After taking a psychedelic, have you had an experience that had an effect on the evolution of attitudes toward your gender identity and/or sexual identity? This would include experiences which were gender-affirming, changed your relationship to the concepts of gender identity and/or sexual identity, helped you accept your gender identity and/or sexual identity, or experiences that challenged your own gender identity/sexual identity. | |
| No | 19.9% |
| Yes | 65.3% |
| Not sure | 14.7% |
| In regards to your psychedelic experience, to what degree: | |
| Did you have a gender-affirming experience? | 13.7% |
| Not at all | 13.7% |
| Very little | 9.7% |
| Somewhat | 28.8% |
| Quite a bit | 26.5% |
| A great deal | 21.2% |
| Did you have a sexuality affirming experience? | |
| Not at all | 5.3% |
| Very little | 8.0% |
| Somewhat | 26.5% |
| Quite a bit | 26.1% |
| A great deal | 34.1% |
| Did your experience help you accept your gender identity? | |
| Not at all | 12.8% |
| Very little | 4.4% |
| Somewhat | 27.0% |
| Quite a bit | 26.1% |
| A great deal | 29.6% |
| Did your experience help you accept your sexual identity? | |
| Not at all | 7.1% |
| Very little | 5.8% |
| Somewhat | 23.5% |
| Quite a bit | 24.8% |
| A great deal | 38.9% |
| Did you experience challenge your gender identity? | |
| Not at all | 30.5% |
| Very little | 18.6% |
| Somewhat | 27.0% |
| Quite a bit | 12.4% |
| A great deal | 11.5% |
| Did your experience challenge your sexual identity? | |
| Not at all | 28.3% |
| Very little | 19.9% |
| Somewhat | 23.0% |
| Quite a bit | 14.2% |
| A great deal | 14.6% |
| Did you feel more open to your gender identity than you did before your memorable psychedelic experience? | |
| Not at all | 11.5% |
| Very little | 6.2% |
| Somewhat | 17.3% |
| Quite a bit | 31.9% |
| A great deal | 33.2% |
| Did you feel more open to your sexual identity than you did before your memorable psychedelic experience? | |
| Not at all | 11.5% |
| Very little | 4.0% |
| Somewhat | 18.1% |
| Quite a bit | 25.7% |
| A great deal | 40.7% |
MEQ30 scores (30-item questionnaire; each question is scaled 0–5 with “0” indicating “none/not at all” and “5” indicating “extreme/more than any other time in my life and stronger than 4”); EBI scores (6 out of 8 validated items used; 6-point Likert scale responses ranged from “No, not at all” to “Extremely, more than ever before in my life”); PIQ scores (23 items; each scaled response ranges from “0 -no; not at all” to “5-extremely, more than ever before in my life”).
EDI: (8 items; each item scored on a visual analogue scale (VAS) from 0 to 100 with the following statements at the lower and upper end, respectively: “No, not more than usually” and “Yes, I experienced this completely/entirely.”).
CEQ: (26-items; responses range from “0-none at all” to “5-extreme, more than ever before in my life”).
Changes in sexual identity exploration and commitment subscales
As shown in Table 3, there were significant changes observed across measures of sexual identity and commitment subscales with effects ranging from small to medium-large. These included effects on commitment (p < .001; d = −0.434), uncertainty (p < .001; d = 0.375), synthesis/integration (p < .001; d = −0.538), and exploration (p < .001; d = −0.688). A small effect was observed in transgender congruence (p < .001, d = −0.228). Additionally, there were significant changes with medium-large effect sizes across an inventory measuring acceptance of sexuality (p < .001; d = −0.636) and difficulties with self-acceptance of sexuality (p < .001; d = −0.728).
Table 3.
Pre-, post-, and change scores for sexual orientation, gender identity, mental health measures in the sample.
| Measure | Observation | Mean(SD) | t | Two-sided p | Effect size (Cohen’s d) |
|---|---|---|---|---|---|
| Transgender Congruence Scale (TCS)^ | Pre | 3.53(0.95) | |||
| Post | 3.74(0.92) | ||||
| Change | −0.21(0.73) | −5.365 | <.001 | −0.228 | |
| Gender Identity Reflection and Rumination Scale^ | Pre | 29.98(10.66) | |||
| Post | 30.25(9.84) | ||||
| Change | −0.27(7.01) | −0.701 | 0.484 | −0.026 | |
| Measure of Sexual Identity Exploration and Commitment – Exploration Subscale^^ | Pre | 29.58(10.32) | |||
| Post | 36.09(8.54) | ||||
| Change | −6.51(10.60) | −11.129 | <.001 | −0.688 | |
| Measure of Sexual Identity Exploration and Commitment – Commitment Subscale^ | Pre | 22.77(7.72) | |||
| Post | 25.89(6.65) | ||||
| Change | −3.12(7.16) | −7.917 | <.001 | −0.434 | |
| Measure of Sexual Identity Exploration and Commitment – Uncertainty Subscale^ | Pre | 9.78(4.74) | |||
| Post | 8.08(4.31) | ||||
| Change | 1.70(4.89) | 6.295 | <.001 | 0.375 | |
| Measure of Sexual Identity Exploration and Commitment – Synthesis Subscale^ | Pre | 19.28(6.53) | |||
| Post | 22.48(5.31) | ||||
| Change | −3.20(6.45) | −8.968 | <.001 | −0.538 | |
| Self-Acceptance of Sexuality Inventory – Acceptance Subscale^ | Pre | 16.95(5.60) | |||
| Post | 20.24(4.71) | ||||
| Change | −3.70(5.65) | −11.881 | <.001 | −0.728 | |
| Primary care PTSD screen for DSM-5^ | Pre | 8.43(4.78) | |||
| Post | 4.08(3.37) | ||||
| Change | 4.35(4.03) | 14.339 | <.001 | 1.051 | |
| Patient Health Questionnaire^ | Pre | 10.66(5.86) | |||
| Post | 5.96(5.05) | ||||
| Change | 4.7(6.12) | 14.119 | <.001 | 0.859 | |
| General Anxiety Disorder ^ | Pre | 10.66(5.86) | |||
| Post | 5.96(5.05) | ||||
| Change | 4.7(6.12) | 14.119 | <.001 | 0.859 | |
| Multidimensional Psychological Flexibility Inventory – Flexibility Subscale^ | Pre | 3.31(1.06) | |||
| Post | 4.28(0.87) | ||||
| Change | −0.97(1.02) | −17.349 | <.001 | 0.996 | |
| Multidimensional Psychological Flexibility Inventory – Inflexibility Subscale^ | Pre | 3.84(1.05) | |||
| Post | 2.92(0.95) | ||||
| Change | 0.92(1.12) | 15.032 | <.001 | 0.918 |
Score range for each measure: TCS (12-item measure; response range from “1-Strongly disagree” to “5-Strongly agree); GIRRS (15-item measure; score range 15–60; responses range from “1-almost never” to “4-almost always”); MoSIEC subscales (22 items total; 6-point Likert-type scale responses range from “1-very uncharacteristic of me” to “6-very characteristic of me;” subscale. Exploration subscale: 8 items; score range 8–48. Commitment subscale: 6; Uncertainty subscale: 3 items; score range 3–18; Synthesis subscale: 5 items; score range 5–30); SASI (34 items total; 5-point Likert scale responses range from “1-totally true” to “5-totally untrue.” SASI Acceptance of Sexuality subscale: 10 items; total score range: 10–50. SASI Difficulties with self-acceptance of sexuality: 14 items; total score range: 14–70); CPTSD-5 (5 items; 0–3 range where “0-not at all” and “3-quite a bit”); PHQ-9 (0–27; scores 10–14 indicate moderate depression; 15–19 moderately severe; ≥20 severe); GAD-7 (0–21; scores above 9 indicate moderate to severe); MPFI (24 items, 6-point Likert scale ranging from “never” to “always” or “never true” to “always true”).
Comparison of mental health variables before and after the psychedelic experience
As shown in Table 3, there were significant decreases with large effect sizes in symptoms of traumatic stress (p < .001; d = 1.051), depression (p < .001; d = 0.756), and anxiety (p < .001; d = 0.859). Responses indicated significant increases in psychological flexibility (p < .001; d = 0.996) and decreases in psychological inflexibility (p < .001; d = 0.918).
Canonical correlation analysis examining the relationship between acute psychedelic effects and changes in self-acceptance and sexual/gender identity measures
As shown in Figure 1, there was one significant canonical correlation (Rc = 0.49; p = .001). For the independent set, the canonical variate was represented primarily by greater intensity of acute effects including mystical-type experiences, emotional-breakthrough experiences, and psychological insights, as well as lower acute challenging effects. The canonical variate for the dependent set was represented primarily by increases in self-acceptance and sexual identity exploration measures including commitment and exploration of sexual identity, self-acceptance of sexuality, as well as transgender congruence. This analysis revealed that the dimensional features of the acute psychedelic experience were significantly related to the dimensional increases in self-reported changes in self-acceptance and sexual identity exploration.
Figure 1.
Canonical correlation analysis depicting a statistically significant relationship between acute psychedelic effects (greater intensity of mystical, emotional breakthrough, and insight expereinces, and lower intensity of challenging experiences) and gender/sexuality-related outcomes (shifts in commitment and exploration of sexual identity, self-acceptance of sexuality, and gender congruence).
Discussion
This study represents an important initial step in understanding the impact psychedelics may have on GSM communities. Although GSM individuals face significant mental health challenges (Meyer 2003), there is little empirical evidence on the role psychedelics may play in developing treatments for this population (Desrochers 2024; Hanshaw et al. 2024; Saade, Hanshaw, and Keuroghlian 2024; Stauffer et al. 2022). To our knowledge, this is the first survey study of GSM individuals reporting psychedelic use in naturalistic settings. Our results suggest that psychedelic experiences may positively impact gender identity, sexual identity, and mental health outcomes. Many respondents indicated that a psychedelic experience influenced their attitudes toward gender and sexual identity, highlighting the need for further research.
Our findings align with existing literature on psychedelics’ therapeutic potential (Bogenschutz and Ross 2017; dos Santos, Bouso, and Hallak 2020; Hasler 2023). Self-reported decreases in traumatic stress, depression, and anxiety, along with increases in psychological flexibility and self-acceptance, suggest that psychedelics may improve mental health and well-being for GSM individuals. These results are promising, given the high prevalence of mental health challenges in GSM populations (Marley, File, and Scherer 2022).
Regarding naturalistic psychedelic use, GSM individuals often reported using psychedelics in early adulthood and had prior psychiatric diagnoses, consistent with studies showing high rates of mental health conditions in this population (Marley, File, and Scherer 2022). Participants reported using psychedelics to explore and affirm their identities, supporting existing research on psychedelics and identity exploration (Cavnar 2014; Ching et al. 2022; Hodges 2020). This study uniquely highlights GSM experiences, a group underrepresented in psychedelic research (Desrochers 2024).
Participants also reported high scores on measures of mystical experience (MEQ-30) and emotional breakthrough (EBI). These findings align with previous research linking mystical experiences with lasting psychological benefits (Griffiths et al. 2006; MacLean, Johnson, and Griffiths 2011). Emotional breakthroughs reported here are consistent with Roseman et al. (2019), suggesting these experiences facilitate emotional processing and insight. Further research is needed to understand the mechanisms behind these effects, especially for GSM individuals.
Significant changes in gender and sexual identity from before to after a psychedelic experience suggest these substances can affect self-perception and acceptance processes. This supports Cavnar’s (2014) findings of similar shifts among gay and lesbian individuals following ayahuasca use. The increases in self-acceptance and reductions in identity-related distress highlight an area for future research into psychedelic applications for treating gender dysphoria and related conditions. However, these experiences occurred in complex interpersonal contexts, and further research is needed to understand the relationship between psychedelics and shifts in gender and sexual identity.
Participants reported decreases in traumatic stress, depression, and anxiety, along with increased psychological flexibility, indicating mental health benefits of naturalistic psychedelic use for GSM individuals. These findings are consistent with studies showing the efficacy of psychedelic-assisted therapy for mental health conditions (Carhart-Harris et al. 2016; Davis et al. 2021; Hasler 2023; Ross et al. 2016), as well as survey data on naturalistic psychedelic use (Raison et al. 2022). Psychological flexibility, a key mediator of these effects, supports theories that psychedelics can disrupt rigid thought patterns and enhance emotional flexibility (Davis, Barrett, and Griffiths 2020; Hayes, Strosahl, and Wilson 1999). Psychedelics may allow GSM individuals to perceive themselves outside rigid cultural narratives that invalidate their lived experiences.
These findings also align with emerging theories on how PAT may address minority stress-related psychopathology. As Hanshaw et al. (2024) suggest, psychedelics may facilitate the relaxation of rigid minority stress-related beliefs, such as internalized homophobia and transphobia and conditioned cisnormativity and heteronormativity. This shift in cognitive and emotional processing may contribute to reductions in chronic shame, hypervigilance, rejection sensitivity, and self-monitoring – factors that play a central role in the mental health disparities faced by GSM individuals (Carlisle et al., 2023). Through mechanisms such as increased psychological flexibility, enhanced emotional insight, and altered self-perception, psychedelics may offer GSM individuals an opportunity to reframe their experiences in ways that reduce the psychological burden of minority stress and foster greater self-acceptance.
Limitations
Despite promising findings, this study has several limitations. First, the retrospective nature of the survey introduces recall bias, as participants were asked to reflect on past psychedelic experiences. Memory distortions may affect accuracy. Second, potential selection bias exists, as individuals with positive or impactful psychedelic experiences may have been more likely to participate, leading to an overrepresentation of positive outcomes. This limits generalizability to the broader GSM population, including those with neutral or negative experiences. Third, the cross-sectional design precludes conclusions about causality. Although associations between psychedelic use and changes in gender identity, sexual identity, and mental health were observed, causality cannot be established. Finally, the predominantly White sample limits the applicability of the findings to GSM individuals of other racial and ethnic backgrounds. The lack of nationality data further prevents an analysis of cultural differences that might influence respondents’ experiences.
Additionally, the length of the survey may have influenced participant retention and sample composition. While the questionnaire length was comparable to other studies in the field, it was inherently demanding, which may have disproportionately affected individuals with neurodivergent traits such as ADHD or autism. As a result, these populations may be underrepresented in our dataset. Furthermore, while attention checks were designed to ensure data quality, it is possible that the demanding nature of the survey contributed to some participants failing these checks, further impacting attrition rates.
We acknowledge that the decision to have respondents focus on their most memorable psychedelic experience inherently limits our ability to explore the effects of multiple substances, varying patterns of use, or the cumulative impact of lifelong psychedelic experiences. Although this singular focus may not fully capture the naturalistic use of psychedelics, especially in community or group settings, or the nuanced ways GSM individuals may experience psychedelics, it serves as a signal for further exploration into the more nuanced aspects of naturalistic psychedelic use in these populations.
Finally, the acute psychedelic measures used, such as the MEQ30, have not been validated for GSM populations, potentially limiting the accuracy of quantitative insights. The reductive nature of such measures may also hinder a comprehensive understanding of these complex phenomena, underscoring the need for qualitative research to explore the mechanisms in greater detail. Future research should aim for more diverse samples in controlled settings to better understand GSM experiences across cultural contexts.
Conclusion
This study provides valuable data on the experiences with psychedelics among GSM populations. These findings highlight the importance of considering the unique needs of GSM people in psychedelic research and therapy. Clinicians should be aware of the potential benefits of psychedelic use reported by GSM individuals, particularly in improving mental health and promoting self-acceptance. Integrating culturally sensitive practices and involving GSM communities in PAT trials may enhance the effectiveness of these interventions. Future research should include longitudinal or controlled trial designs to establish causality and explore underlying mechanisms of action among GSM populations. Studies with more diverse samples are necessary to understand GSM experiences across racial and ethnic backgrounds. Researchers should also consider socioeconomic status, social support, and financial stability in future surveys and trials to better understand how these factors influence the effects of psychedelics among people who are GSM. Additionally, future studies should consider how PAT can be tailored to meet the specific needs of GSM individuals, ensuring that treatment models integrate intersectional and culturally responsive approaches (Ching 2020). Expanding on these frameworks will be critical for developing psychedelic therapies that effectively address the unique psychosocial challenges faced by GSM populations.
Acknowledgments
We would like to give special thanks and acknowledgments to Tristan Boyer, Djinn Thompson, and Chloe Leo for their help with survey development, and DanceSafe for their help with recruitment.
Funding
The study was supported with internal funds from the Center for Psychedelic Drug Research and Education at the Ohio State University. AKD and NG were supported by the Johns Hopkins Center for Psychedelic and Consciousness Research, funded by private philanthropic funding from Tim Ferriss, Matt Mullenweg, Craig Nerenberg, Blake Mycoskie, and the Steven and Alexandra Cohen Foundation. AKD, RL, MD, DQ, SS, MS, and AN were supported by the Center for Psychedelic Drug Research and Education, funded by anonymous private donors. JS was funded by the NIH Midcareer Investigator Award in Patient-Oriented Research grant [K24DA051328]. The funding sources had no role in the study, data analysis, interpretation, or communication of findings.
Disclosure statement
RL and AKD are founding board members of the Source Research Foundation. RL also received funding from the Usona Institute. NG was a co-investigator on a multi-site study of psilocybin for major depressive disorder, funded by the Usona Institute, a not-for-profit organization. JS, MD, SS, DQ, MS, and AN have no conflicts of interest to declare.
Data availability statement
The data that support the findings of this study are available from the corresponding author upon request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon request.