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

Abstract

The interconnections of multiple minority stress and masculinities diversely operate to impact racialized gay, bisexual, transgender, and queer (GBTQ) men’s mental health outcomes. However, limited research has explored the connections to racialized GBTQ men’s suicidality within Canadian contexts. Guided by interpretive descriptive methodology and using virtual photovoice methods, the current study addresses this gap by drawing on the narratives of 26 Canadian-based racialized GBTQ men. Using constant comparison analytics, three interconnected themes were inductively derived: (i) suppressing isolation and emotional pain, (ii) processing the underbelly of suicidality, and (iii) building mental health strategies. In suppressing isolation and emotional pain, participants spoke to a lack of social support and capacity to fully deal with their suicidality. In this context, distracting themselves from suicidal thoughts was used as a means for staying alive. In processing the underbelly of suicidality, participants reflexively interrogated an array of marginalizing experiences and inequities, with the goal to better understand and waylay their suicidal thoughts. Lastly, in building mental health strategies, participants engaged professional and/or relational supports to sustainably manage and mitigate their suicidality risks in the long term. These findings provide crucial insights for tailoring culturally and gender-responsive mental health promotion and suicide prevention programs that can help racialized GBTQ men manage their suicidality and bolster their mental health resilience in the long term.

Keywords

suicidality masculinities minority stress racialized sexual and gender minority men

Introduction

Gay, bisexual, transgender, and queer (GBTQ) men in Canada experience higher risk for suicidality compared to cisgender, heterosexual men, with numerous studies documenting intra-group differences in suicidality rates within the GBTQ men community (Fernandez et al., 2025). For instance, gay and bisexual men living with HIV experience higher suicidality risks compared to those who do not have HIV (Ferlatte et al., 2017), while transgender men are five to eight times more likely to attempt suicide compared to the overall male population (Veale et al., 2017). Comparing gay and bisexual men, Hottes et al. (2016) and Liu et al. (2023) report bisexual men as having a higher likelihood of suicidal ideation and/or attempts. For racialized Canadian-based GBTQ men however, their experiences of suicidality are under-reported, with limited evidence detailing the socio-structural determinants influencing their resilience and circumstances when managing suicidality. This is especially crucial since racialized GBTQ men continue to endure the compounding effects of racism and cisheterosexism that heighten their suicidality risk (Boyd et al., 2025; English et al., 2022). Addressing this knowledge gap, the current study’s purpose is to detail Canadian-based racialized GBTQ men’s experiences of and strategies for managing suicidality. Specifically, the current article distils the contexts and complexities surrounding racialized GBTQ men’s suicidality and seeks to elaborate the ways in which racialized GBTQ men draw on their strengths and challenges to manage their suicidality.

Multiple Minority Stress, Masculinities, and Racialized GBTQ Men’s Lives

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.

Methods

Study Design

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.

Sampling and Recruitment

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.

Table 1.

Participant Demographic Details (N = 26)

	N (%)
Age (years) (range: 19–47; mean = 27.5; SD = 7.19)
19–29	18 (68)
30–39	5 (20)
40–49	3 (12)
Province
British Columbia	14 (52)
Ontario	10 (40)
Alberta	1 (4)
Quebec	1 (4)
Race
South Asian	9 (32)
East Asian	5 (20)
Black	4 (16)
West Asian	3 (12)
Mixed-race	3 (12)
Southeast Asian	2 (8)
Sexual orientation
Queer	12 (48)
Gay	7 (28)
Bisexual	5 (16)
Pansexual	2 (8)
Gender identity
Cisgender man	15 (60)
Transgender man	8 (28)
Non-binary	3 (12)
Relationship status
Single	16 (60)
Partnered	10 (40)
Suicidality
Ideation	26 (100)
Plans	15 (60)
Attempt(s)	9 (36)

Note. While the sample is collectively referred to as racialized GBTQ men, when making references to individual participants, their self-identified sexual and gender identities are included to contextualize their quotes and visuals. Apart from “GBTQ men,” the following terms (and its accompanying definitions) are used to refer to participants and sample populations in cited literature: (i) sexual minority men: men whose sexual identity, orientation, or practices differ from the heterosexual majority, (ii) transgender men: men whose gender identity differs from what is associated with the sex they were assigned at birth, and (iii) Two-Spirit: a cultural identity used by Indigenous people that reflects a sexual orientation and gender/spiritual identities that is made up of both male and female spirits (Government of Canada, 2024).

Data Collection

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.

Data Analysis

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.

Results

Presented as three distinct yet interconnected themes, the findings—accompanied by representative quotes and photographs—illustrate the diverse ways in which racialized GBTQ men’s management of their suicidality was contextually bound to minority stressors and dominant masculinities.

Suppressing Isolation and Emotional Pain

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.

Photograph 1.

Doodle

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.

Processing the Underbelly of Suicidality

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.

Photograph 2.

Listening to music and podcasts

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.

Building Mental Health Strategies

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.

Photograph 3.

Dessert

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.

Discussion and Conclusion

In featuring racialized GBTQ men’s diverse experiences with minority stressors, and the ways in which they reckoned with and resisted masculine norms to waylay and manage their suicidality, the current article contributes to existing evidence (Han, 2021; Johnson et al., 2025; Rana et al., 2024) by offering Canadian-specific insights. In what follows, we discuss what these findings mean within the broader context of building culturally and gender-responsive mental health promotion and suicide prevention programs for racialized GBTQ men in Canada.

In the current study, suppressing isolation and emotional pain emerged as a legitimate holding pattern for managing suicidality among racialized GBTQ men, as they navigated experiences of multiple minority stress. While these findings may contrast past evidence that have broadly elucidated the maladaptive consequences of emotional suppression that can amplify risks of suicidality (Pettit et al., 2009; Kaplow et al., 2014), we argue that the employment of suppression as a strategy for managing suicidality is highly contextual and may confer protection in some circumstances. For racialized GBTQ men in the current study, the suppression of isolation and emotional pain was partly characterized by the concealment of their sexual and gender identities driven by a lack of social support and heightened threats of racism and cisheterosexism from their families and sociocultural communities. Reflecting minority stress complexities, this adds a new dimension for understanding how concealment of sexual/gender identities—and the suppression of isolation and emotional pain—can offer temporary refrains and respite from inequities (Pachankis et al., 2020) and quell the worsening of suicidality, resonating with Klonsky and May’s (2015) Three-Step Theory of Suicide that established pain, hopelessness, and lack of connectedness as central factors in one’s progression from suicidal ideations to suicide attempts. For some participants in the current study, conforming to masculine norms including stoicism and emotional restraint to suppress their isolation and emotional pain could have also been a way to preserve their social capital as men and withstand the compounding experiences of marginalization linked to their subordinate masculine status as sexual/gender minority men (Lu et al., 2019) and racialized and/or immigrant men (González, 2025; Nyaga & Torres, 2017; Sowad & Lafrance, 2024). That said, we acknowledge that suppressing isolation and emotional pain is not a long-term suicidality management strategy, given its negative impacts on sexual and gender minority people’s mental illness, suicidality, and self-identity injury in the long term (Singh et al., 2022).

As racialized GBTQ men worked to process the underbelly of their suicidality, they utilized diverse strategies including journaling, listening to music, and physical exercise to interrogate their emotional pain and etch pathways for quelling their suicidal thoughts. The benefits of such adaptive work have been widely reported in past research, with Pachankis and Goldfried (2010) describing the value of engaging in expressive writing in improving individuals’ psychosocial functioning, which can extend to influence positive responses to feelings of isolation, hopelessness, and emotional pain. Similarly, the use of music and physical exercise can confer cognitive and somatic benefits that aid mood regulation, coping with loneliness (Martín et al., 2021), and lower likelihood for anxiety and depression (Davidson et al., 2013; Zaatar et al., 2024), all of which are helpful in building environments for racialized GBTQ men to deconstruct the underbelly of their suicidality. In the context of the current study, participants frequently processed their suicidality alone, primarily due to on-going struggles with racism and cisheterosexism that inculcate fears for getting external support, and racialized GBTQ men’s tendency to draw on self-reliance to manage their suicidality. That said, while helpful in affirming their resilience, agency, and identity as racialized GBTQ men, these internal strength-based resources for processing suicidality are finite, wherein the isolation of this solitary self-work may actually worsen mental health (Meyer, 2015). Further, it may divert attention from the larger socio-structural inequities invoked by racism and cisheterosexism—issues that are primarily responsible for racialized GBTQ men’s minority stressors and suicidality risks in the first place (Meyer, 2015).

In building mental health strategies to manage their suicidality, racialized GBTQ men reimagined their masculinities, resisting stoicism and self-reliance to instead embrace their vulnerabilities and bridge to professional and relational supports. While this resonates with past research emphasizing the need to reject rigid harmful masculinities and promote healthier masculinities as a suicide prevention strategy (Trail et al., 2021), our findings add how reimagining masculinities can norm help-seeking and waylay various forms of minority stressors deterring racialized GBTQ men from accessing and/or engaging mental healthcare (Patterson et al., 2025). For racialized transgender men and transmasculine people, the specific benefits of gender-affirming care as a mental health strategy are tied to their agency and autonomy as they construct and express their masculinity (Johnson et al., 2025). In addition to decreasing depression and suicidality risks among gender minority men (Tordoff et al., 2022), gender-affirming care also redefines how and who gets to construct, express, and perform masculinity, all of which are central in the promotion of healthy masculinities among racialized GBTQ men. That said, it must be acknowledged that gender-affirming care remains highly individualized wherein processes of gender affirmation and actualization differ for each person (Koehler et al., 2026). In terms of garnering relational supports via cultural connections, collectivist values underpin the ways in which it helped racialized GBTQ men navigate minority stress and manage their suicidality. This supports previous findings that collectivism and cultural connections foster a sense of belonging (Dong et al., 2023) and aid positive mental health outcomes (Moore et al., 2022). This also affirms Parmenter et al.’s (2021) emphasis on community resilience (characterized by collectivism) as a long-term mental health strategy for racialized sexual and gender minorities, as a way to overcome oppression and exclusion within and beyond the queer community. Indeed, cultural connection can redefine how collectivism embeds subaltern immigrant masculinities in Western contexts (Sowad & Lafrance, 2024).

These findings have several implications for the development of culturally and gender-responsive mental health promotion and suicide prevention programs for racialized GBTQ men. First, community-led mental health promotion programs for racialized GBTQ men should acknowledge how racism and cisheterosexism are interconnected to uniquely impact their strategies for managing suicidality—whether to suppress their isolation and emotional pain or process the underbelly of their suicidality. That said, strategizing equity-focused efforts tailored to their unique needs and concerns might include hiring racialized queer counsellors to lead mental health promotion efforts and/or creating support groups tailored for racialized GBTQ men. This can help create safe and supportive avenues for racialized GBTQ men to reduce their isolation and thoughtfully engage emotion work toward interrogating and addressing the minority stressors that fuel their suicidality. At an institutional level, family-focused initiatives are also warranted in providing culturally sensitive, queer-affirming support to racialized families with children or members who self-identify as sexual and gender minorities. Co-led by community partners and individuals with shared identities and lived experiences, families can be equipped with the resources and tools needed to reconcile their own sociocultural beliefs and support for family members who are racialized GBTQ men—a key strategy in mitigating the latter’s suicidality risks without them having to rely on individual resiliencies to manage their suicidality. Systemically, investments are needed to build cultural adaptability and gender-responsiveness into the Canadian mental healthcare system. This includes training clinicians and other support persons to meet racialized GBTQ men where they are at, while being aptly resourced to work through diverse cultural and gendered experiences. Further, given that access to mental healthcare and gender-affirming care are key for racialized GBTQ, political will and funding are needed to tailor services that bolster racialized GBTQ men’s resiliencies for managing suicidality in the long run.

There are limitations to consider in this study. The cross-sectional nature of the study design does not capture life course changes linked to racialized GBTQ men’s suicidality. Further, there may have been socio-political events influencing participants’ safety and mental health that were not explicitly discussed. The focus on a Canadian-based sample, a country with legal provisions and policies (at the federal level) that protect sexual and gender minority people, also limits transferability of the findings to other countries with different legislations that negatively impact sexual and gender minority people. To address these limitations, future work might usefully conduct longitudinal studies that span multiple countries with diverse sociocultural norms and legislations pertaining to sexual and gender minority health. Methodologically, the English-language requirement in the current study, the use of online formats, and required literacy regarding taking photographs may have excluded some groups within the target population. Future studies might incorporate the use of different languages as inclusion criteria—to align with the diversity of racialized groups in Canada. Future work might also seek to engage under-represented sub-groups (e.g., Black, Indigenous, Afro-Caribbean, Middle Eastern, and Latin American) to test and elaborate the current study findings.

In conclusion, by delineating how multiple minority stress and masculinities interconnect to influence racialized GBTQ men’s experiences of and strategies for managing suicidality, the current study indicates the need for tailoring policy, and training men’s mental health promotion support workers and designing suicide intervention programs in Canada. Herein, racialized GBTQ men would be better able to equitably optimize their mental health outcomes in the long term. Further, it is key to note that the thematic findings do not exist in a linear fashion. Instead, they are context-specific and entwined with the ever-evolving circumstances of racialized GBTQ men’s lives.

Footnotes

ORCID iDs

Calvin C. Fernandez

Trevor Goodyear

John L. Oliffe

Ethical Considerations

Ethics approval was obtained from the University of British Columbia Behavioural Research Ethics Board (UBC BREB) (H24-01728).

Consent to Participate

All participants provided informed written consent prior to participating in the study.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was made possible with funding from the University of British Columbia School of Nursing’s Lyle Creelman Endowment Fund. Calvin C. Fernandez is supported by the University of British Columbia’s 4-Year Doctoral Fellowship via the Reducing Male Suicide Research Excellence Cluster and John L. Oliffe’s Tier 1 Canada Research Chair in Men’s Health Promotion. John L. Oliffe is supported by a Tier 1 Canada Research Chair in Men’s Health Promotion.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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