Managing Suicidality: The Experiences of Canadian-Based Racialized Gay, Bisexual, Transgender, and Queer (GBTQ) Men

Characterized by the intersections of racism and cisheterosexism, multiple minority stress encompasses proximal stressors (internalization of stigma/discrimination) and distal stressors (enacted and anticipated stigma/discrimination) that can negatively impact racialized GBTQ men’s physical and mental well-being (Cyrus, 2017; McConnell et al., 2018) and heighten their risks for suicide (English et al., 2022; Ferlatte et al., 2019). Masculinities also operate hierarchically in racialized GBTQ men’s lives to influence their gendered practices as they navigate inequities and marginalizing forces that risk their mental health (Han, 2021; Johnson et al., 2025). Defined as socially constructed gendered ideals and norms expected of men (Connell & Messerschmidt, 2005), masculinities are performed and co-constructed by GBTQ men across a continuum aligning to and rejecting stoicism, emotional restraint, and dominance (Johnson et al., 2025; Lu et al., 2019).

Multiple minority stress and masculinities interconnect to impact racialized GBTQ men’s physical and psychological well-being in diverse ways. Specifically, racialized GBTQ men may endure marginality linked to their minority racial and sexual identities with the layering effects of masculine ideals that confer power and award social capital to cisgender, heterosexual men (Connell & Messerschmidt, 2005). For instance, in sexual and romantic relationships, racist stereotypes linked to hypermasculinity and/or femininity dehumanize racialized GBTQ men as sexual caricatures, whereby they are stratified based on a spectrum of desire that idealizes White masculinity as the standard for attractiveness (Giwa, 2022; Han, 2021; Nguyễn & Han, 2024). As a result, racialized GBTQ men are both fetishized for their stereotyped Black/Latino brutish masculinity (Collins, 2004; Mora, 2011) and rejected for their perceived femininity (Han, 2021); the latter typically linked with East and Southeast Asian men (Thai et al., 2025). Such stereotypes can erode racialized GBTQ men’s self-esteem, heighten their social isolation, and challenge their mental health. For racialized transgender men and transmasculine people, mental distress and suicidality risks are further amplified by cissexism (the stigmatization and discrimination of non-cisgender people) that underpin their hypersexualization, exclusion, and invalidation within a broader society that associates masculine desirability with being cisgender (Johnson et al., 2025).

Multiple minority stress and masculinities are also entwined to influence racialized GBTQ men’s socioeconomic status. Racism is deeply embedded in hiring policies and promotion practices (Salari et al., 2024) while prior research has highlighted how employers draw associations between perceived non-heterosexuality and GBTQ men’s lack of competence for higher-level professional careers (Tilcsik, 2011). Consequently, racialized GBTQ men who are open about their sexual/gender identities may be less likely to receive job offers and tend to attract lower performance ratings and salary packages. For racialized GBTQ men who are immigrants/refugees, the precarity of transnational migration (including risks of xenophobic discrimination) creates additional cultural, employment, and language barriers that worsen their socioeconomic status (Sowad & Lafrance, 2024). This in turn influences how they construct and perceive their own masculinity within a Western context, where the inability to provide for others and self-sustain may render them further marginalized as men (Sowad & Lafrance, 2024), and heighten their mental health vulnerabilities (González, 2025).

In the context of the current study, using a strengths-based approach to decipher how multiple minority stress and masculinities entwine to influence Canadian-based racialized GBTQ men’s experiences of and strategies for managing suicidality offers crucial insights for tailoring culturally and gender-responsive mental health promotion and suicide interventions. This is especially important since racialized GBTQ men’s suicidality is under-represented in the Canadian context (Fernandez et al., 2025) despite racialized people making up over 25% of the Canadian population (Hou et al., 2023). Further, racialized GBTQ men face significant socio-structural inequities in Canada including housing, food, and economic insecurities due to the compounding effects of racism, cisheterosexism, and xenophobia (Rainbow Health Ontario, 2022). Without being able to self-sustain, these inequities can amplify tensions for reconciling marginalized masculinities to worsen racialized GBTQ men’s mental health and suicidality risks.

The current study drew on interpretive descriptive methodology—a qualitative research approach rooted in constructivist epistemology to generate rich applied knowledge to directly inform practice (Thorne, 2016). Virtual photovoice methods were used to engage racialized GBTQ men across Canada in taking and narrating photographs to discuss their suicidality. Recognizing the under-representation of racialized GBTQ men’s suicidality experiences and the linkages to multiple minority stress and masculinities, virtual photovoice—as a participatory action research method—was purposefully used to empower and center participants’ visuals and voices, with the goal of being seen and heard by policymakers (Oliffe et al., 2023; Wang et al., 1998). Emphasizing participant agency and autonomy, racialized GBTQ men were invited to share what was most important to them as a means to document and affirm their experiences and guide the development of culturally and gender-responsive mental health promotion and suicide prevention programs in Canada.

Using purposive sampling, participants were eligible if they (i) self-identified as a racialized GBTQ man, (ii) were 19 years old or older, (iii) currently resided in Canada, (iv) spoke and understood English, and (v) previously experienced suicidality, encompassing suicidal ideation, plans, and/or attempt(s). In the context of this study, being racialized is defined by social processes wherein individuals are categorized based on physical characteristics and cultural background, positionalities which may culminate in unequal power differentials and inequities assigning less social privilege and capital to men who are not White (Lett et al., 2022). With the support of queer community organizations nationwide, study recruitment posters detailing the researcher’s contact information, study inclusion criteria, and honoraria were disseminated in person and via social media including LinkedIn, Instagram, and X. Interested participants contacted the first author via email and were subsequently invited to complete a Zoom eligibility meeting to be briefed about the study’s objectives, procedures, and consent details. Of the 53 participants who were followed up after contacting the first author, 19 (36%) did not respond to our email reply, while 34 (64%) confirmed their availability to attend the eligibility meetings in which they were oriented to taking 5 to 10 photographs that best illustrated their experiences of and strategies for managing their suicidality. Out of the 34 people who completed the eligibility meetings, 8 (24%) did not complete their consent forms or submit their photographs ahead of the Zoom interviews. A total of 26 eligible participants were ultimately included in the study, as they provided written informed consent and completed sociodemographic forms, ahead of uploading and submitting their photographs on Qualtrics prior to their photovoice interview. All participants ranged in age from 19 to 47 years (M = 27.5, SD = 7.19), and each received $100 CAD honoraria for their time and contribution to the study. Over half the participants were single at the time of the interview (N = 15; 56%), and a majority resided in British Columbia (N = 14; 52%) and Ontario (N = 10; 40%). Most participants self-identified as South Asian (N = 9; 32%), East Asian (N = 5; 20%), and Black (N = 4; 16%). Three participants self-identified as mixed-race (N = 3; 12%) (see Table 1 for full participant demographics). Throughout the study, all participants self-identified as men. However, in the demographic questionnaire and individual interviews, some participants self-reported their gender identity and experiences as non-binary (N = 3; 12%). Acknowledging how past experiences of gender socialization as men influenced their experiences of and strategies for managing suicidality, these participants offered additional diversity and nuance in which to interpret the connections between multiple minority stress, masculinities, and suicidality.

Ethical approval was obtained from the University of British Columbia Behavioural Research Ethics Board (H24-01728) prior to the start of study recruitment. Due to the sensitive nature of the study topic, careful measures were taken to prioritize participant safety and well-being. All participants were informed of the benefits and risks for participating in the study, and their right to withdraw at any time. Participants were also provided with comprehensive mental health resources and a photography guide prior to the start of data collection. The photography guide detailed some prompts for participants taking their photographs—for instance, we suggested photographs illustrating scenarios, places, spaces, and people that represented strengths and challenges for managing suicidality. Participants were also provided information needing consent to take photographs of other people—and to avoid taking incriminating photographs of themselves or others. To mitigate suicidality-related risks for participants, only those who were not experiencing suicidality at the time of study enrolment were eligible to participate—this was self-reported by participants during the Zoom eligibility meetings. The first author (who was also the sole interviewer) completed an accredited suicide alertness training course prior to the start of data collection and followed a suicide distress protocol to respond to potential suicide attempt disclosures and mental health emergencies during the interviews. The suicide distress protocol equipped the interviewer with information to recognize participants’ self-harm risk and help connect them with supports. The supports were detailed verbally during the Zoom eligibility meetings and at the start of the photovoice interviews, and in writing in the consent forms. To establish trust, safety, and comfort with participants during interviews, the first author (a racialized cisgender gay immigrant man) introduced and positioned himself within the study context, explaining reasons for why the study was being conducted. This was done recognizing how the presence of tacit knowledge can facilitate in-depth sharing (and understanding) of participants’ experiences, while nurturing rapport and safety. Individual Zoom interviews were conducted between August 2024 and September 2025, with each interview averaging between 1.5 and 2 hours. Using a semi-structured interview guide, participants were asked about diverse aspects of their suicidality, and to elaborate how their submitted photographs (shared via Zoom’s screen sharing option) illustrated their experiences and strategies for managing suicidality. Reflexive memos were made by the interviewer for each interview, detailing participant observations including gestures and reactions, as well as key insights and reflections about the interview process and overarching narratives. The Zoom interviews were audio- and video-recorded and transcribed verbatim using an ethics-approved AI transcription tool (Temi™). All 26 interview transcripts were checked for accuracy by the first author—listening to each participant’s recorded interview while simultaneously comparing the transcripts to ensure all data were accurately captured, before being anonymized with researcher-assigned pseudonyms. Participants’ photographs (N = 196) were inserted into their anonymized transcripts, which were uploaded to NVivo 12 for coding.

Drawing on constant comparison analytics, the process of distilling thematic patterns and accounting for variations across categories occurred with data collection as new insights were used to refine and expand initial interpretations of the data (Charmaz, 2006). Participants’ photographs were used to facilitate dialogue during the interviews (Oliffe et al., 2023), as they reflected on, interpreted, and described different objects, spaces, people, and/or activities in their photographs to illustrate their experiences and management of suicidality. While previewing participants’ photographs, their interview transcripts and reflexive memos were read and reread to gain contextual familiarization and generate pre-analytical insights. Guided by the overarching research question “What are racialized GBTQ men’s experiences of, and strategies for managing suicidality?”, the first author used an inductive approach to coding to analyze participants’ interpretation and elaboration of their photographs, and suicidality experiences. In doing so, broad preliminary codes that spanned participants’ diverse narratives regarding their suicidality were developed as descriptive categories, while multiple minority stress (McConnell et al., 2018; Meyer, 2003, 2015) and masculinities (Connell & Messerschmidt, 2005) theories were used as sensitizing concepts to interpret categorical patterns. Specifically, they were used to explain participants’ experiences with minority stressors, and the ways in which they reified, resisted, and reckoned dominant masculinities when managing suicidality. The categories were iteratively defined and differentiated with the author team, which included on-going feedback and discussion of the data. In doing so, three distinct but interconnected themes were derived and finalized in the writing of the findings for the current article: (i) suppressing isolation and emotional pain, (ii) processing the underbelly of suicidality, and (iii) building mental health strategies. We also purposefully included a few photographs that best illustrated our generated thematic findings. Reflexive measures used throughout the data analysis process included on-going discussions and collaborative feedback from a senior author and input from the research team (three of whom are sexual minority men, including a racialized cisgender gay man as the first author). Specifically, we drew on the author teams’ diverse positionalities—as queer health researchers and gay men with lived experiences of minority stress and suicidality (first and second authors) and senior researchers (third and fourth authors) to reach a consensus for interpreting participants’ narratives.

Suppressing isolation and emotional pain characterized participants’ management of their suicidality, as racism and cisheterosexism diversely manifested to amplify their vulnerabilities. Underpinned by a lack of social support, varied degrees of familial and societal rejection, and limited capacity to process their feelings, participants recognized that suppressing isolation and emotional pain could usefully distract them from suicidal ideations, without necessarily having to work to understand or find ways to eradicate the cause or triggers of their suicidality.

Linking his suicidal ideation to past experiences of internalized racism and homophobia, Lee, a 22-year-old East Asian cisgender gay man, described how he had “always wanted to be White” to buffer the feelings of isolation that deprived him of a sense of belonging when living in a predominantly White community in Saskatchewan. Connecting these challenges to his suicidality, Lee spoke to the interiority of the isolation and emotional pain he experienced:

I think one of the main reasons why I was depressed and suicidal is because I was gay … I wasn’t happy with being gay. I didn’t accept it. I always thought it would be better to be straight … Growing up, it felt like I was never one of the boys or I didn’t fit in with the girls … I didn’t fit in with anyone … When I was in Saskatchewan. It’s more, it’s predominantly White, so that made me feel more alone too.

In suppressing the isolation and emotional pain underpinning his suicidality, Lee was vigilantly stoic and self-reliant, aligning to those masculine ideals as he refuted and denied his sexual identity while attempting to embody a straight-passing identity. Here, his gay identity was concealed, even (and perhaps especially) from himself to avert the profound loneliness and risk of ridicule for being so out of place as a racialized gay man: “I was like straight-acting. I was really good at hiding my sexuality.” Lee also explained using cannabis to secure some respite from the pressures of isolation and emotional pain: “I rely on weed to pause my emotions, so I didn’t have to deal with it. There wasn’t an addiction, it’s just there’s a reliance.” The risks of self-medicating were deliberate and defensible for Lee, a practice contextually bound to blunting the ever-present minority stressors that fueled his suicidality. Similarly, most participants who disclosed substance use positioned it as an intentional therapeutic strategy to reduce the intensity of the emotional pain aggravating their suicidality. That said, Lee also recognized self-medicating as a holding pattern rather than a long-term strategy, conceding, “It didn’t help me get better, but at least it kept me alive.”

Oliver, a 24-year-old cisgender East Asian gay man, described the physical and emotional abuse perpetrated by his father as underlying his suicidality. Oliver understood his father’s abuse as primarily linked to a deep-rooted misogyny toward his now ex-wife, a behavior that extended to the rejection of Oliver as a gay man. Listing the net effects of that abuse for fueling his isolation and emotional pain, Oliver recalled, “It made me want to die.”

I think the abusiveness toward me was because he [father] divorced from my biological mother. And he sees me, he thinks of her, and he hates her. He hated her. He hates her. He hates her still … And he has some stresses himself, and he has no one to not take it out on. So, he chooses me.

Deprived of the affections and safety he craved from his father, Oliver’s injurious past layered onto his minority stress and marginalized masculinity. Here, the lack of “emotional validation” and the growing abandonment from his father, “he wouldn’t accept, he wouldn’t hear of me talking about like my gayness,” left Oliver with little hope of ever being able to build a loving relationship with his father. Oliver lamented and ruminated on that:

In my mind, the father would go out and look at some resources and materials on how to navigate this relationship [father-gay son relationship], but he didn’t do any of that. He didn’t really provide any relevant resources either. So, I just kind of figure out how to protect myself in this space of like the gay community.

Reeling from the isolation beset by his father, Oliver explained suppressing the emotional pain as buying him time to quell the suicidality he endured. Oliver used sketching as a distracting strategy, and submitting Photograph 1 titled Doodle; he explained that it provided a way of “diverting [his] attention to something else,” especially at the height of his father’s abuse and his own lack of capacity for deconstructing his suicidality:

With drawing, it’s like a detachment. So, I’m able to, you know, divert my attention to something else and in that temporary estrangement from those consuming thoughts, I’m able to at least have some space to kind of recuperate and recharge.

Foregrounding an etched caricature of a somewhat forlorn man (a fictional character; not the study participant), the scribbles and jagged lines within and outside the character might have reflected the intensity and messiness of Oliver’s emotional pain. But Oliver instead suggested the sketch was without meaning in its content, but deeply therapeutic in the art of doodling about nothing in particular. This nothingness provided respite from the pressures of trying to interrogate an array of cause–effect factors central to his suicidality. In this regard, suppressing isolation and emotional pain with doodling punctuated and paused Oliver’s ruminating suicidal thoughts to feel less emotions and reduce his suicide risk.

Describing a lack of support systems, Ismail, a 26-year-old queer transgender South Asian man, explained how religiosity was used by his family to justify their cissexism against him as a transgender Muslim man, invoking his isolation and emotional pain. Herein, Ismail explained that he had always “been one to look for distractions” to suppress the emotional pain, which included visiting art galleries as a way of distracting himself from suicidal thoughts and navigating hopelessness:

To a degree it [suppressing isolation and emotional pain] has helped. I feel like it’s also impacted me negatively in many ways because it has meant that I don't have—have not interrogated certain feelings … for a very long time. But I feel like in the grand scheme of things, it helped because it kept me alive.

Similar to Lee and Oliver, Ismail recognized distraction as a survival measure. However, these strategies and ultimately the struggles with suicidality were solitary, as Ismail went on to clarify: “It’s not something that I could put on someone else,” despite recognizing that it was “definitely something that I just needed people around me for.” Ismail also conceded that he felt pressured to “perform masculinity a lot more” since starting his gender transition. Here, amid his struggles with suicidality, Ismail bought into masculine ideals for outwardly being “more of like the big guy” because he did not “feel it internally” during the early stages of his gender transition. Grappling with suicidality at the intersections of cissexism and masculine norms, Ismail’s tactics for suppressing isolation and emotional pain were ultimately recognized as worsening his suicidality.

In summary, suppressing isolation and emotional pain emerged as solitary practices for participants buying time at the height of their suicidality, whereby masculine ideals for self-reliance were implicated (and entangled) as distracting strategies and respite for staying alive. Time limited however, participants also recognized the need for bridging those strategies to processing the underbelly of their suicidality more fully, to ease their suicide risk.

Moving beyond suppression to processing the underbelly of suicidality, participants engaged the work of interrogating the diverse ways minority stressors and masculinities fed their suicidality. In doing so, participants labored to deconstruct and ideally disarm the factors heightening their suicide risk.

Describing minority stressors linked to past abuse by his ex-partner and familial rejection for being gay, Omar, a 29-year-old West Asian cisgender gay man, explained his use of music and lyrics, and self-help podcasts as a cathartic emotional outlet to unpack feelings linked to his suicidality. Submitting Photograph 2 titled Listening to Music and Podcasts, Omar clarified his preference for processing his feelings solitarily, wherein he “liked to be alone” because it was “more peaceful, more happier” with background songs and dialogue:

Listening to music—it’s very helpful in my experience because music helps you process your feelings. Sometimes … let’s say when you’re heartbroken … listening to sad songs can help because you want to cry, you want to release these emotions, you want to feel them.

Listening to music and podcasts in the privacy of his own home, Omar was in touch with his own feelings, as he detailed his autonomy for where and what he could listen to as a means for processing the underbelly of his suicidality. Conceding that “it was very hard for [him] to ask for help” as a man and that he was also unable to confide in others due to past traumas, “I no longer trust to tell others [his struggles],” Omar gave himself permission to feel his emotions by himself as a protective measure. This included describing Miley Cyrus’ song titled “Flowers” (that was about her independently dealing with a painful break-up with an abusive ex-boyfriend) as “empowering,” that helped Omar feel both validated and invigorated to “move on quicker and gain [his] sense of self-worth.”

Explaining how journaling helped him reflexively visualize the context and potential implications of his suicidality, Ibrahim, a 34-year-old West Asian cisgender queer man, noted the therapeutic value of expressive writing (and reading what he had written) about how and why he wanted to end his life as a mechanism for dealing with multiple minority stressors. This reflexive process aided some level of thought reframing for Ibrahim, pausing his ruminating suicidal ideations and plans at the height of his distress and suicidality:

When I want to kill myself, I would write it. Once I see it, I was like—when your eyes see it, I think it’s different. Even if you say it out loud, like either say it out loud and hear it, or just write it and see it, you think it’s more real and then you just, “no, I don’t want that.” Then I’ll start writing why I’m feeling this way and what did I do before to help me divert from this thought.

Here, overlapping stressors including HIV stigma, the lack of structural support as an asylum-seeker, and having to navigate tensions in reconciling his sexual identity and maintaining relationships with family and friends back in his home country came to the fore as underbelly issues to be deconstructed. Intentionally, Ibrahim also reimagined his masculinity, claiming strength in addressing his suicidality vulnerabilities as a racialized queer man living with HIV. In doing so, he freed himself of the constraints imposed by his stoicism and emotional restraint—masculine characteristics he was socialized with as a West Asian man that previously worsened his experience of minority stress and suicidality.

Explaining how his suicidality manifested at the height of the COVID-19 pandemic when he was still a teenager living in India with his parents, Vivek, a 19-year-old South Asian cisgender gay man, now living in Ontario, explained how being trapped at home in India inhibited “the emotional maturity that [he] needed, to have an [intimate] relationship that sustained.” With lockdown measures in place and having to endure societal hostility toward queer people, Vivek felt trapped, isolated, and hopeless about the possibility of freely exploring and embracing his sexual identity as a young gay man. In this tumultuous context, Vivek went on daily runs that provided an outlet for processing the underbelly of his suicidality. Exercising was key to “help [him] focus [his] mind on trying to solve problems,” as Vivek secured some relief and partial remedy in understanding the causative agents for his suicidality, and his need to escape those conditions. This introspective work—and the ability to separate and visualize something better—aided Vivek’s mental health. That said, Vivek also recognized the pandemic hardships as impacting everyone, and he reflected on the support and protections he was receiving in India amid feeling trapped within a cisheterosexist society:

At some point I did feel a little bit selfish because I had so much to be grateful for that a lot of people didn’t have … I did talk to my parents about the fact that I didn’t really enjoy living there [India]. I think at the time my mom was hurt by that … and so to see her hurt kind of made me withdraw a little bit more.

Embodying masculine norms and expectations that emphasize a son’s responsibility to his parents’ well-being, the pressures grew for Vivek to conceal his own mental health struggles for his parents’ well-being, despite realizing that he needed to leave India for his own good. Ironically, the protections intended by Vivek were dual—to save his family from the shame of having a gay son and to afford himself a more open and authentic life elsewhere. Again, in processing the underbelly of his suicidality, Vivek engaged the work of deciding how to best live rather than die.

Diverse resources and resiliencies for processing the underbelly of suicidality were used by participants. Herein, there were alignments to masculine norms of self-reliance and strength to engage their introspective processing work. In addition to recognizing these cause–effects pathways, many participants also began engaging professional and relational supports when building mental health strategies, as a way of bolstering their mental health resilience in the long term.

Many participants bridged the work of processing their suicidality to building mental health strategies. These included engaging professional and relational supports, as a means to manage their suicidality and promote their mental health resiliencies in the long term.

Foregrounding the compounding effects of substance use and discrimination shaped by his racial and sexual minority identity, Elan, a 47-year-old mixed-race cisgender gay man, explained how he contemplated suicide amid wanting to escape unrelenting feelings of isolation and hopelessness. Specifically, Elan described being “othered” and devalued because of his mixed-race background, substance use, and queerness, for instance, facing “outright rejection as soon as someone finds out [he is] mixed race” at gay clubs and being shunned by others at the height of his substance use. Describing his rock bottom as leaving no alternative but to enlist psychiatric care, Elan credited his psychiatrist “for the fact that I’m alive today”:

I was diagnosed with borderline personality disorder and PTSD and methamphetamine dependency. And yeah, we [Elan and his psychiatrist] had to clean up the meth and we had to deal with the borderline … And I laugh about it now, but yeah. At the time, like when he diagnosed me, like some of the diagnoses made sense to me … at least I know what I’m working with … I was actually kind of grateful to have something to work with.

Elan’s narrative about acting on his mental illness crisis is among the most often told stories in men’s suicidality, wherein diagnoses are made, and treatment accepted as a last resort and life-saving epiphany. Unstuck from suppressing with substances, Elan suggested that working with a clinician who “made [him] feel safe” and “helped [him] see that [he] could get through it [trauma and suicidality]” was the crux for navigating his multiple minority stressors and managing his suicidality. Elan added, “I think he [psychiatrist] allowed himself to be vulnerable with me and that helped me be vulnerable with him.” Here, masculine hierarchies were forgone, and instead, a therapeutic relationship centered on norming vulnerability, safety, and mutual care was the foundation for sustainably addressing Elan’s mental illness.

Detailing the struggles he endured during the early stages of his gender transition, Ismail, the 26-year-old South Asian transgender man who was previously quoted, explained how incompatibility between the way he looked and how he wanted to look as a man fed his insecurities and amplified his suicidality: “I was feeling extremely suicidal, especially when I was still presenting as a girl [at the beginning of his gender transition].” It was not until Ismail started his weekly testosterone-based hormone replacement therapy (gender-affirming care) that he finally felt that he could comfortably embody and embrace his masculinity, which in turn transformed the ways he perceived himself. Ismail added:

I have a beard now, like, which is so great. Like my energy levels are great. My voice is deeper. Like every time I’m on the phone with someone, like I always get “sir” “boss” or you know, like “buddy” … I’ve never gotten misgendered even like, since the beginning of taking testosterone … testosterone has just been like a major lifesaver for me, honestly. Like I don’t know if I would’ve been here if I didn’t start [testosterone].

In the context of Ismail’s masculinity, the fact that he was validated by others for his gender identity and expression underscored the co-constructed nature of being seen as a man and alleviated some of the minority stressors he had previously endured. Being on testosterone replacement therapy, Ismail’s body ascetics melded his manly mind and body, revealing the power of affirming his gender as aiding Ismail’s mental health. The gender-affirming care in and of itself was positioned as key to Ismail managing his suicidality. Further, rather than a binary, Ismail also recognized his inclusivity and comfort with all the ways he could now embrace and perform his gender: “As I feel like I am more outwardly seen as a man comparatively to before, I’m more willing to embrace femininity.”

Chen, a 22-year-old East Asian queer transgender man, explained how the interconnected experiences of racism and cissexism influenced his decision to hide key aspects of himself and his cultural background, including his mother tongue to assimilate to Western cultures. This however resulted in Chen feeling more displaced and isolated, and lacking a sense of sociocultural belonging, all of which heightened his suicidality:

Because I have been at some point in my life very assimilated [to North America] and I really hated myself for it. And I have gone through high school without speaking Chinese or eating Chinese food. So, when I met my siblings and like … you won’t imagine how shit my native language was, even though it was like my mother tongue, because I haven’t spoken it.

Addressing the layered effects of multiple minority stressors, Chen was determined to reconnect with his cultural roots as a way of belonging to and honoring his East Asian identity for the benefit of his mental health. Submitting Photograph 3 titled “Dessert,” featured was a traditional East Asian dessert—two bowls of skimmed milk and a colorful bowl of taro balls (which is typically mixed in with the milk). Symbolically indulging in this famous East Asian delicacy with his brother when he was back in China, Chen emphasized his need and efforts for aligning to his Chinese cultural identity, which included embracing family as a source of relational support:

I’m trying to like, tell myself that I am worth nurturing. And also, it is something that, like, it is one of my strongest cultural ties because I don’t have access to a lot of like Chinese community here [Canada]. I keep wanting to cook for like a bigger community or like, at least my family. I don’t want to just feed myself.

For Chen, re-embracing Chinese cultural norms centered around being with (and for) others was crucial for mending the void and lack of belonging he previously experienced. Specifically, Chen aspired to “reclaim [the culture] as something as part of [him],” embracing collectivist values to bolster his mental health, and perhaps waylay some of the minority stressors he endured as a racialized transgender man in Canada. Also reflected here were Chen’s masculine values, where collectivist care was embraced as what Chinese men legitimately do. Elaborating on this, Chen added, “I think that’s what a healthy masculinity feels like to me—is to like care for who you consider family deeply and to support them emotionally and physically.”

With participants building mental health strategies to manage their suicidality—including professional care and relational supports—it was clear that the wide-ranging contexts were reliant on specific culturally and gender-responsive remedies.