Transgender and gender-expansive psychedelic users’ concerns about colonization, racism, and medicalization in western psychedelic science

Psychedelics have long histories of use in Indigenous communities for healing, spiritual, and ceremonial purposes. In contrast, Western psychedelic science has emerged through frameworks shaped by colonization, racism, and medicalization. These systems often marginalize and exclude the very communities most impacted by trauma, including transgender and gender-expansive (TGE) individuals, especially those who are Black, Indigenous, and People of Color (BIPOC). Informed by Black feminist epistemological methodology, we conducted 20 hour-long, semi-structured interviews of TGE individuals who have used psychedelics. The interviews explored how race, ethnicity, and culture related to TGE people’s naturalistic psychedelic use and their perspectives on psychedelics. Data was analyzed using thematic analysis. Participants discussed using psychedelics to heal from identity-based traumas such as trauma from racism and/or transphobia. Some participants highlighted the Indigenous roots of psychedelic plant medicine and demonstrated awareness of inequities surrounding psychedelic access due to structural racism. As part of this discussion, some participants were opposed to the ongoing medicalization of psychedelics and discussed how medicalization was related to racism and colonization. TGE participants raised critical concerns about the reproduction of colonial and racist dynamics within Western psychedelic research, highlighting how these structural inequities shape both access to and experiences with psychedelics. New models of PAT that are culturally humble and ethically responsible need to be developed to promote health equity as psychedelic substances are integrated into Western medical contexts, particularly for TGE BIPOC. • Psychedelics may be helpful to support healing from negative race-based experiences • Racism may lead to inequitable access to and benefit from psychedelics • Ongoing medicalization and colonization of psychedelics may exacerbate existing inequities • Racism, colonization, and medicalization interact in intersectional and circular ways