Another critical question is the weight we ought to place on drug-induced insights. Psychedelics are known to dissolve critical filters and amplify subjective certainty. A single LSD, psilocybin, or ketamine experience can produce overwhelming conviction – “I am trans” or conversely “I never was” – with a noetic quality (felt truth) that feels more certain than months of sober reflection. Metaphysical belief changes can persist for six months or longer, yet prospective studies reveal little lasting change in core metaphysical or religious convictions – suggesting initial certainty often fades without reinforcement. In a survey on extended difficulties with psychedelics, 23% of users struggled with identity-related difficulties, with approximately one-third of the total sample’s issues persisting beyond a year.
It is not clear whether and how often clinicians screen for psychedelic influence on gender realisation. Notwithstanding the prevalence of psychedelic use in the queer community, no prospective controlled study has tracked individuals who experienced strong gender insights on psychedelics to measure how many retained that conviction one, five, or ten years later, or how common this phenomenon is.
Gender-affirming care is not to be taken lightly, and nor, of course, is the risk of suicidality from failure to transition. Interventions like testosterone therapy can increase cardiovascular risk, reduce fertility, and damage orgasmic capacity. There is a paucity of high-quality evidence regarding the long-term benefits and risks of hormone replacement and surgery for suicide risk and gender dysphoria. Historical studies of children with classical, early-onset gender dysphoria suggested that a majority desisted from transgender identification by adolescence or early adulthood. In the 2000s, Dr Az Hakeem mixed pre- and post-surgical patients in group therapy. After hearing detransition testimonies, 98% of the pre-surgical cohort abandoned their transition plans. These observations suggest the conviction itself is plastic when exposed to counter-narratives. At the same time, among transgender women who did not receive transition medical care, suicidal ideation rates were as high as 75.2%, with significantly lower rates among those who received care.
Official regret rates for transition are usually quoted as being exceptionally low – around 0.5%. This figure is derived from a handful of investigations, such as the ‘Amsterdam study’, of whose cohort 36% of participants were lost to follow-up. Likewise, suicides, despite being reported at 20-fold higher rates in post-surgical populations compared to cisgender counterparts, were excluded from that analysis. Moreover, the study’s narrow definition of regret omitted individuals who desisted without returning to the clinic, those who regretted surgery but opted not to report it, and those who discontinued medical transition prior to gonadectomy.
Other studies of detransition indicate a rate as high as 35% among trans men after four years, for instance. These studies were also conducted in an era when patients were overwhelmingly adult, male-to-female, and had lived with dysphoria for years before treatment. Contemporary cohorts often look little like this: they are younger, predominantly natal-female, often have recent-onset dysphoria, and frequently present with autism, trauma, or same-sex attraction. None of the large, modern surges – such as the 50-fold increase in the UK – have been tracked with comparable rigour. Given that regret in the ‘Amsterdam study’ occurred on average 130 months post-surgery, and that the surge in adolescent referrals began only around 2011, one critical commentator contends that the applicability of these findings to current youth cohorts remains uncertain.
Online communities such as r/detrans, which as of November 2025 listed nearly 60,000 members, highlight the presence of a real and growing community. Until registries mandate long-term, independent follow-up – tracking every patient for at least a decade, regardless of whether they stay in treatment – the true scale of regret and detransition will remain unknown.
International clinical guidelines through WPATH require mental health concerns to be stable before gender transition treatment. ICD-11 criteria advise that gender incongruence must have persisted for about two years, with confounding conditions excluded. This ought to protect against the risk of psychedelic false insights. FOI requests issued to UK NHS gender identity clinics and NHS England (with the exception of Northampton) revealed no systematic policy or data collection on drug-related insights.
Cumbria emphasised that gender-related distress must be persistent, however it was induced. Sheffield confirmed that it holds no documented guidance. Devon’s team excludes patients with alcoholism and present addictions, and may defer patients with “substance misuse” affecting “ability to engage,” potentially triggering discharge. Nottingham explicitly stated there is “no clinical evidence” for waiting periods after drug-induced gender insights. Leeds stated that “if someone attributed a gender identity issue to drug use, we would not be moving forward”.
It seems that transgender patients who experience gender realisations on psychedelics may be navigating a clinical system with no shared protocols, depending instead on variable clinical discretion.
It is also important to distinguish temporary persistent identity shifts from signs of mental health issues, though they will be intensely interwoven. Fisher (2022) documents cases where gender dysphoria appears only during acute psychotic episodes and resolves after treatment. Lundberg et al. (2024) found that up to 25% of young people with schizophrenia report gender dysphoria – sometimes persisting after psychotic symptoms improve. Substance use complicates matters: cannabis-triggered OCD sometimes manifests as gender-identity obsessions, while dissociative drugs can blur body-dissociation for already-stressed queer individuals.
A 2025 case report in the Journal of Psychedelic Psychiatry describes a young adult already socially and hormonally transitioned who, on 300 µg of LSD, experienced abrupt cessation of suicidal ideation and a decision to halt medical transition entirely. Chloe Cole, the most visible American detransitioner, began detransitioning at 17 after experiencing hallucinations during an LSD trip, after having undergone puberty blockers, testosterone, and a double mastectomy by age 15. Multiple Reddit testimonies follow the same pattern: psychedelics dissolve the felt necessity of transition, producing not regret but relief at having escaped what now feels like a category error.
A 2025 systematic analysis of LSD experiences found that just over 10% of non-cisgender authors found decreased self-acceptance. Around 30% of cisgender users reported encountering a gender-variant identity for the first time that persisted post-trip.
The drugs do not reliably point in one direction.
Ed Prideaux | Community Blogger at Chemical Collective
Ed is one of our community bloggers here at Chemical Collective. If you’re interested in joining our blogging team and getting paid to write about subjects you’re passionate about, please reach out to Sam via email at samwoolfe@gmail.com
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Knowing yourself is the first step to beating mental dysphorias of any kind in my opinion. It’s a shame LSD does not get more recognition. Great article.