I’ve had, by my own rough count, several hundred trips in my life — none under strict clinical supervision, all of them, I’d argue, in service of becoming a slightly less awful version of myself (and having fun along the way). I’ve written before about what happens in that nakedness with yourself, in that bubble you form with your fellow psychonauts (people who take psychedelics): “I call this psychedelic intimacy. It makes for a strong connection.” What I’ve not been able to answer, despite having had four genuine experts on psychedelic-assisted therapy (PAT) on my podcast, is a question a listener put to me recently: does any of this work differently for men than for women? I started to think about: Do men and women have the same or similar expectations? How different are the journeys, conversations, and outcomes?
I went looking for some answers. What I found instead was a field that is, by its own researchers’ admission, barely asking the question at all.
Who’s Actually in the Room?
Start with who shows up for treatment, because that, at least, is counted — though even the counting is contested. I put the gender question to Dr Alex Belser, a researcher I’d had on the podcast, and his reply set the tone: “the research is much better at telling us who participates than how gender shapes the treatment.” His best figure is a 2025 systematic review of 21 psilocybin- and MDMA-assisted therapy trials, 1,034 participants: 55.4% women, 44.6% men — a trial-sample figure, he noted, not everyone receiving PAT in clinics or retreats. A separate 2025 analysis of eight psilocybin trials put women at 47.7% instead. His caution: don’t read either number as proof that PAT is predominantly sought out by one sex over the other.
Here’s the catch, and it’s the whole story in one sentence: of those 21 trials, only four put sex or gender into the outcome analysis. We know who turns up. We know almost nothing, rigorously, about whether it works the same way once they’re there.
Even the headline numbers hide a trap. In the landmark 2023 phase 3 MDMA trial, 71.2% of the 104 participants were female— but in the group that received MDMA, it was 60.4%. Either way, more females than males. One of the areas that will surely be worth exploring concerns participants with a non-traditional or non-binary sexual identification. Belser flagged this in his email to me: “One distinction I’d preserve in the write-up is between biological sex and gender.” Trans and nonbinary experiences are poorly captured in any of the data.
A fiddlehead doesn’t show which way it’s going to unfurl until it does. That’s close to where the research on gender and PAT still sits: we can see the curl; we can’t yet say what shape it takes for any one person.
Do Men and Women Even Want This Differently?
Do men and women wish to participate equally in PAT? Are expectations the same? A 2025 Australian survey of 254 mental-health consumers found men significantly more likely than women — and than gender-diverse respondents — to expect PAT to work and to prefer it over conventional, non-psychedelic talk therapy. Real but moderate gaps: solid enough to be trusted, not big enough to be dramatic. Once the researchers adjusted for age, prior psychedelic use, and — above all — how disappointing people’s past experience of ordinary talk therapy had been, gender dropped out as a predictor of wanting PAT at all. What mattered was the non-psychedelic therapy you’d already sat through, not your sex.
A separate 2025 PTSD-focused survey of over 500 people found the opposite emphasis: both sexes reported very high willingness to try MDMA- or psilocybin-assisted therapy — most respondents, male or female, scored at or near the top of the scale — but women’s scores sat measurably, statistically lower than men’s, both for joining a trial and for taking the treatment once approved. Not a contradiction, just two true things at once: nearly everyone is willing, and women are a little less willing to go through with it than men, on average. I went looking — including through PubMed — for research on whether men and women actually seek, or come away with, different things from PAT: emotional connection and relationship healing versus ego dissolution. I found none that makes that comparison directly. The nearest relative is a small clinical study finding women report more intense subjective and perceptual effects from MDMA than men — a difference in intensity, not in what people are after. So “women seek emotional healing, men seek ego dissolution” stays a line that sounds good in a podcast promo, unconfirmed by anything I could find.
What My Own Guests Have Seen
For now, there’s no published research on gendered outcomes with PAT. All I have is the anecdotal evidence — which I take seriously, while labelling it exactly that. When I asked Jay Godfrey, cofounder of Nushama in New York, whether gay men having psychedelic therapy showed different patterns, his answer was: “My thought is they are more emotionally connected, more vulnerable and often more open to being helped [than heterosexual men].” The Nushama team set out that roughly 60% of their clients are women, 40% men, with a disproportionate share of those men — particularly in New York — identifying as LGBTQ. Their own observation, offered as anecdote rather than data: “women are seemingly having more nuanced journeys rich with beautiful narratives and specifics on who or what they saw… for men, like me, the experience is extremely abstract, often devoid of a specific key golden nugget.” Not worse. Just less legible.
I put a version of the same question to Martijn Schirp, formerly of the Synthesis Institute in Amsterdam, now building something new of his own, Upayosis. His answer reinforced how little research has been done on the topic: “I don’t have specific, reliable statistics on the breakdown of men versus women in PAT, or rigorous data on the difference in clinical outcomes based on gender. Much of the clinical research remains focused on general efficacy rather than gender-stratified data.” That, in its own quiet way, is the finding.
Sarah Lynn Thomas, co-CEO of Behold Retreats, gave me a concrete version of the same pattern in the podcast we recorded together. Plan a mixed retreat and sometimes you still get single sex anyway: an all-male group formed by accident when only men signed up. Her own words: “It was interesting to learn how much more they would share just with men.” Whatever is happening physiologically, who else is in the room changes what gets said aloud. It also matches what facilitating has taught her about herself: “if you are vulnerable, the team building can be more connected… we can be strong and still be moving through healing and expansion.”
This papery seed case is from a lunaria plant — commonly called honesty, for how it dries thin enough to show you exactly what’s inside. The biology behind psychedelic response isn’t nearly that transparent yet.
Same Protocol, Different Body?
The MDMA trials that won FDA attention ran one dosing framework for everyone: three 90-minute preparation sessions, three eight-hour dosing sessions a month apart, 80mg-plus-40mg rising to 120mg-plus-60mg later. No separate female and male protocols. That may be sound, unbiased medicine — or an assumption nobody has actually tested. What of the different body sizes, for example?
There’s a biological question under all of this with too little airtime. “Hormones, menstrual cycles, and menopause may influence psychedelic response,” Belser told me, pointing me to a review of potential biological sex differences and a companion piece on including more women in trial design. Pregnancy and breastfeeding exclusions in trials add a further blind spot. None of this has reached practice yet — “to my knowledge there aren’t gender-specific PAT treatments,” he said, though one is being explored: PAT for PMDD, premenstrual dysphoric disorder, which is hormonally driven almost by definition.
There are safety signals worth taking seriously. A 2024 review, “Women and MDMA: particularities of gender and sex,” reported greater female sensitivity to MDMA’s subjective effects, more anxiety and adverse effects, and greater susceptibility to hyponatraemia (dangerously low blood sodium). The caveat: that review covers MDMA use broadly, not risk inside a supervised protocol. A reason to look harder, not a verdict.
On safeguarding — therapist conduct, boundaries, consent — the record needs scrutiny. The Institute for Clinical and Economic Review’s evidence report on MDMA-assisted therapy for PTSD says, in its own words, that “boundaries, including sexual boundaries, were severely crossed with at least one patient in a Phase II trial” — this despite the trial requiring one male and one female therapist in the room together. The report details one such case: a participant who said her psychiatrist and the psychiatrist’s unlicensed therapist husband broke from protocol to make intimate physical contact with her during a session while she was under MDMA, and who later reported a non-consensual sexual relationship with the unlicensed therapist. ICER doesn’t put a running total on cases like it — “at least one” is as far as the report itself goes. A woman and a man in the room was not, by itself, an adequate safeguard.
Sarah Lynn Thomas screens for exactly this risk from the other end, before anyone takes anything. Behold’s guests pass medical and psychological screening before a ceremony, because, as she told me, “It’s not just are you going to be safe at our ceremony? It’s about everybody in that circle because you also care about them.” Clinical trials have ethics boards; retreats, by her account, have to build that discipline themselves.
So, Does It Work Better for One Sex?
The honest answer, after all that: nobody knows, and the research as designed can’t yet tell us. The 2023 MDMA trial found greater improvement among female participants — but that showed up in both the MDMA and placebo-with-therapy groups, a finding about who benefits from structured attention generally, not about women responding better to MDMA. The closest thing to a direct sex comparison in the psilocybin literature was published last month: a reanalysis of the psilocybin-versus-escitalopram* trial found no sex differences on depression measures. There was a signal of lower anxiety among the women, but the sample was small and the analysis exploratory — in Belser’s words, “an interesting lead, rather than a settled finding.” Not detecting a difference isn’t proof of equality either; a real effect could still sit undetected for years.
So here’s where I land, for now. Women are well represented in these trials by headcount — 55.4% in the broadest review, 47.7% in the psilocybin-only count — but headcount isn’t the same as being studied, and it’s no basis for claiming PAT is mainly sought by, or built for, one sex. The protocols are shared, the safety signals provocative rather than proven, the biology underexamined, and the people running these treatments — three of them guests of mine, plus the researcher who answered my questions directly — are candid that their best evidence is still anecdotal. An honest accounting of a field that scaled faster than its own research did.
I’ll keep an eye on what Mind Medicine Australia, the FDA pipeline, and researchers like Alex Belser publish next; all have mentioned more granular, gender-stratified data to come as these therapies move into the mainstream. Questions that would be worth exploring, between men and women in Psychedelic Assisted Therapy:
- how different are the expectations/objectives and approaches to PAT?
- how does sex change the lived experience?
- how is the inner journey different?
- are there any insights or patterns that emerge in terms of sexuality and gender?
- how different is integration?
- what difference in the outputs and results?
As I wrote a while back, reflecting on my own trips: “it propels me to be more conscious of my non-importance in the grand scheme of things.” Whichever sex gets there first, that part, at least, seems to be shared. Until then, you decide: is this a gap worth demanding better data for, or one that quietly closes on its own as the field matures?
P.S. If you’d like to see more podcasts and articles that I’ve conducted or written on the topic of psychedelics, I have a special Psychedelics category that regroups them. Please do take a “trip” down that rabbit hole!
*Escitalopram is a prescription antidepressant medication that belongs to the selective serotonin reuptake inhibitor (SSRI) class.
