Chemsex as a phenomenon is, for a number of reasons, largely associated and connected with men who have sex with men (MSM).

Today, most activism is driven by queer men who recognize that understanding chemsex’s connection to queer male culture is central to understanding the motivations and risk factors involved. However, it’s difficult to escape the fact that trans people are often excluded, forgotten or categorized in inappropriate ways in conversations about "MSM". The Chemsex field is no exception.

While people engaging in chemsex have largely managed to handle and recognize transgender people's participation, transgender people have always been a thorn in the side of researchers and relief measures. There are several reasons for this but at the centre is an idea that "biology," and specifically one's assigned gender at birth, is the only thing that matters when it comes to sexual and reproductive health.

In practice, this means that trans men have often been excluded or forgotten in work related to "MSM", while trans women have often been wrongly categorized as queer men. Non-binary people have often not been considered at all, but have traditionally been placed in categories based on their assigned gender at birth.

For trans men, this has meant that they have been denied access to research and important resources, such as PreP, unless they are assumed to be cis men or have not been asked about their trans status. As a result, there is a lack of information on the specific challenges trans men who have sex with men face, not least when it comes to chemsex specifically.

While trans men have often been explicitly excluded from research and resources for MSM, trans women are more often included as a target group. It is important to clarify that including someone linguistically, or as a group in the research one pursues, is not the same as understanding or working with that group in a way that actually highlights their specific needs. Today, trans women are often included in the category "MSM" in theory, but in practice most measures are designed specifically for men and seldom address issues that are relevant to trans women specifically.

Does this mean we have to ignore chemsex's link to male queer culture and identity in order to manage to include trans people? Of course not. Trans people who participate in chemsex often have a strong connection to queer male culture and are likely to practice sexual relations with gay and bisexual cis men.

This proximity to queer male culture and sexual practices means that trans people participating in chemsex with queer men share the same challenges as other chemsex users. Those same challenges should include them as an important group to reach out to within harm prevention work. Trans people involved in chemsex face the sames risks of sexually transmitted infections, overrepresentation of people with problematic drug use, vulnerability to abuse, and a high representation of selling sex. The need for active inclusion of trans people in injury prevention work becomes even clearer when we consider how that trans people are generally more exposed to all these factors.

In Norway, there has been little research into trans people's use of illegal drugs, but the first living conditions survey with a representative sample found that as many as 15% of Norwegian trans men and trans women drank heavily at least once a week, compared to around 3% of cis people. If we look beyond Norway towards international figures, it soon becomes clear that trans people are also overrepresented when it comes to illegal drug use.

According to the largest survey ever carried out on trans people, with as many as 28,000 respondents, almost one in three answered that they had used drugs other than alcohol during the past 30 days. Among trans people who work in so-called "underground industries" (e.g. sex work and porn), the figure was a whopping 68%.

When it comes to HIV infection, trans people who have sex with men are overrepresented. Trans women are particularly vulnerable, and a recent meta-study on the HIV status of trans people on a global basis found that trans women were 66 times more likely to have HIV compared to the rest of the population. New estimates also show that around 14% of trans women in the United States are living with an HIV diagnosis, with a significant overrepresentation among black and Hispanic trans women.

For transmen, there is very little research on HIV that takes into account trans men who have sex with men specifically, but the latest figures available indicate that trans men also have a significantly higher risk of HIV infection than cismen. The same meta-study mentioned above concluded that trans men (regardless of orientation) were around 7 times more likely to have HIV than the cis population. An American study conducted at the largest sexual health clinic in the country found that a 11% of transmen who have sex with cismen had tested positive for HIV during the study period, compared to 3% among other service users.

The estimates become significantly higher when sex sales are included in the calculation, where it’s estimated that trans people who sell sex have ca. a 16 times higher risk of HIV infection than other trans people. The fact that trans people are so vulnerable only underscores the importance of harm reduction work and organized information.

Due to the lack of research categorizing trans people in appropriate ways, it’s much more difficult to give general advice to trans people as a group. For example, most resources are made with the bodies of cisgender men and women as references, and do not take into account how a body with a testosterone-based hormone system and XX chromosomes will react. As a result, the focus in this article will be trans people who participate in chemsex environments with cis men, and who have undergone various forms of gender affirming treatment.

Here are some things that you should think about if you yourself are a transgender person who engages in sexualized drug use or you are a cisman who has sexual partners who are transgender.

It is well documented that cisgender women can be affected differently by some forms of drugs than cisgender men, which will be addressed further in this article. The reason for such gender differences is less known. As a result, it can be much more difficult to know which reference frames to relate to if you are transgender and undergoing gender affirmation treatment. It would be wise to start with doses that are in the lower tier, when planning to take a substance that has different recommendations for men and women. This is especially true if someone is interested in taking something they have not tried before, or are at a party where they’re unsure of the strength or content of what they’re given.

Gender affirmation treatment, and hormone replacement therapy in particular, can change how a body reacts to drugs. Here, too, there is little research, but many trans people themselves say that they experience a marked difference in how they react to drugs before and after medical transition. This can range from tolerating more or less of a substance than before, or that simply reacting differently. A common side effect of hormonal treatment for trans women can, for example, include overheating more easily. No matter the gender identity, this means that trans people should be careful when assuming they have the same tolerance level before starting hormone replacement treatment, as well as an awareness that some drugs may now take longer to work.

At many chemsex parties and other gatherings where the aim is to have sex and get high, it can there is often one person taking responsibility for dosing and distributing drugs to participants at the party, or to their partners. Quite often, the same doses are used for all participants, especially when it comes to drugs that are snorted or swallowed. As mentioned above, this can be particularly problematic for trans people, who for various reasons can have a tolerance level lower than most cis men.

For trans people partaking in chemsex, make sure that you have control over how much you take and don't be afraid to adjust the dose if you suspect that what you have been served may be too much for you.

Most of the time, the sexual risks in penetrative vaginal sex are based on relatively young cis women, which means that these estimates often aren’t suitable for assessing sexual risk for trans people. Trans women and non-binary trans femmes who have constructed or neo-vaginas will often have less elasticity and less natural lubricant than cis women.

The same applies to trans men and non-binary trans mascs people who take testosterone. One of the effects of testosterone is that over time the mucous membranes in the vagina become thinner and weaker, which affects the vaginas natural ability to lubricate. This applies in particular to those who have had either their uterus and ovaries removed, or people who have undergone hormone replacement therapy for a long time.

There are a whole range of factors that make trans people in chemsex settings more likely to end up in unpleasant situations than others. Being the only trans person present can make it more difficult for many to set boundaries or speak out in the face of transphobia or unpleasant situations, and can make someone feel pressured to ignore their boundaries. Having sex with strangers who don't understand how transgender bodies work can make sex more uncomfortable and drugs can end up working differently for you than for others, making you more vulnerable to exploitation.

In addition, cis men as a group often have a physical advantage over both trans women and trans men, whether it is due to body size or the effect of hormones on strength and muscle mass. All of these factors can make a trans person more vulnerable to abuse and unpleasant experiences in chemsex settings. If you are trans and participating in chemsex where all or the majority of participants are cismen, try to make sure you have at least one ally present and be aware that the risks are greater for you than for cismen.