Psychedelic-assisted Therapy: Unique Hope to Support Mental Health Among Trans People
By Jae Sevelius, PhD
When Mikayla learned that psychedelic-assisted therapy using psilocybin mushrooms could help with depression, she wondered if mushrooms could help her too.
She had grappled with gender dysphoria and related suicidal thoughts since early puberty, often falling asleep wishing she would wake up as a cisgender person – or not wake up at all. Searching online, Mikayla read about a few studies exploring the potential of psychedelic conversion therapies to “cure” transness.
Unable to find a suitable clinical trial, she took psilocybin mushrooms on her own. Contrary to freeing her from what she perceived as the burden of being trans, Mikayla's experience led to a profound realization—there was nothing inherently wrong with her. She wept with gratitude and mourned the years she lost to self-hatred.
For the first time, she saw clearly that she was surrounded by people unable to see beyond their own limited perspectives of gender, unable to provide the support and affirmation she needed. With the help of the mushrooms, she saw herself as a beautiful, magical human connected to a vast lineage of past, present, and future humans who live beyond the binary.
Psychedelic-assisted psychotherapy (PAT) has received substantial attention in recent years. This form of therapy includes the medically supervised use of psychedelic medicines such as MDMA, psilocybin, LSD, and ketamine, in conjunction with psychotherapy, specifically designed to optimize the mental health benefits of these medicines.
Heralded as a breakthrough treatment for several mental health conditions, including depression, anxiety, post-traumatic stress disorder, and addiction, PAT represents hope for people who have tried traditional treatments that have failed them. Despite growing evidence of efficacy and safety, however, access to PAT remains largely inaccessible to those who need it the most.
As a clinical psychologist and researcher focused on transgender health care, I know how often individuals like Mikayla feel they must navigate this complex terrain alone. Psychedelic experiences and transgender identities both have been medicalized and pathologized—even criminalized—by the Western medical model.
Since the early 1970s as part of the War on Drugs, the United States government has categorized psychedelics as Schedule I substances deemed to have no medical benefits and high potential for abuse, despite a promising line of psychiatric research and no evidence that these medicines are addictive. Outlawing psychedelics has had profound consequences, leading to mass incarceration and the suppression of further research into the mental health benefits of psychedelics for more than four decades.
Also in the mid-20th century, Western medicine began to develop treatments for trans people with the assumption that being transgender was a mental disorder that needed to be cured. Scientists attempted conversion therapies to turn queer and trans people into straight and cis people, and even studied the potential use of psychedelics for this purpose. Unfortunately, such practices continue today, despite their documented harms. This was the research that Mikayla encountered when she sought to “cure” her transness using psychedelics.
Trans people underrepresented in clinical trials
Currently, PAT (excluding ketamine) is legally accessible only within the context of clinical trials. There are long waiting lists of people who hope to enroll, and long lists of criteria that exclude most people. Trans and gender expansive people are vastly underrepresented in clinical research, and trials of PAT are no different.
This means that, like Mikayla, most people seeking healing with psychedelic medicines today do so outside of the medical context. This has been true throughout human history in cultures around the world for more than 5,000 years. In the United States, underground therapists have been offering these medicines safely and effectively to people who have experienced transformative, sometimes lifesaving, benefits for decades.
While PAT does not eliminate structural barriers to care, its promise does represent a unique hope for transgender people. PAT can increase gender affirmation in multiple ways, fostering self-compassion and providing a pathway for reconnecting with oneself and others. Some people report psychedelic journeys that result in a mystical or unity experience can unleash a sense of “divine blessing,” described as having one’s higher power communicate affirmation of the highest order. Ideally, people will have a trained therapist to guide them during the session.
With a gender-affirming therapist, the client will experience connection and affirmation. Those like Mikayla who experiment with psychedelics on their own also report a renewed connection with their body and heightened self-compassion. In addition to increasing access to gender affirmation, PAT may also reduce the need for gender affirmation from other people, as many come away with a visceral understanding that true affirmation must first come from within.
Offering optimal care requires us to continuously question medical control of the human experience and the ways we have internalized this control. We must continue to create safe, supportive spaces where trans people can express themselves fully, collaborate with each other, and build solidarity across different communities. In this way, we all can experience more freedom, both individually and collectively.
There is much internal work to do alongside the external work of navigating and transforming these systems, but as we do so, we reclaim the right to healing for all. We all must reclaim the right to make choices about our own bodies and futures. This includes embracing all healing modalities – including psychedelic experiences—that offer hope. In this way, people like Mikayla will not have to navigate this terrain alone.
Jae Sevelius, PhD (they/them), professor of medical psychology (in psychiatry), has devoted their career to advancing health and reducing barriers to care for transgender communities.