BACKGROUND: Transgender (trans) and gender-diverse (TGD) people are a small but increasingly visible population who experience worsening marginalisation characterised by toxic political and media discourse, violent hate crimes and discriminatory laws targeting healthcare and public access. Governments in both the United Kingdom (UK) and the United States (US) have pushed anti-trans policies which threaten to further exclude TGD people. Understanding the public health impacts of transphobia is vital, especially regarding disproportionate drug-related harms.

MAIN BODY: TGD people are more likely than their cisgender counterparts to experience both acute and chronic drug-related harm. This is, in part, driven by rising transphobia and perpetuated by limited access to gender-affirming and harm reduction services. Current health data systems fail to accurately capture the scale of drug-related harms faced by TGD people due to suboptimal gender measurement. Inclusive data collection and culturally competent harm reduction services are urgently needed to address these disparities. Digital interventions, such as telehealth, and peer-led support may improve the accessibility and effectiveness of care for this group.

CONCLUSION: Evidence suggests that TGD individuals face disproportionate drug-related harm compared to cisgender people, a disparity likely to widen as government-led hostility increases in countries such as the UK and the US. Immediate action is required to ensure TGD people are fully represented in research, public health monitoring, and support services.