Vulnerability of transgender individuals to substance use in India: a scoping review

Background In India, transgender individuals are more exposed to the risks of substance use disorders. Despite legal progress and increased visibility, they continue to face substantial marginalization in Indian society. This scoping review aims to summarize existing research on their vulnerability to addiction and substance use, identify gaps in evidence, and make recommendations for future research.Methods Following PRISMA guidelines, a comprehensive literature search was conducted up to September 2025 across multiple databases.Results Twenty-five studies were included, most of which primarily focused on alcohol. The vulnerability of transgender populations in India is closely linked to stigma and violence. Substance use is associated with risky sexual behaviors, engagement in sex work, increased HIV vulnerability, and barriers to healthcare access. Victimization, depression, anxiety, and suicide risk were frequently reported as being associated with substance use.Conclusion This review highlights the heightened vulnerability of transgender populations in India to substance use, with prevalence exceeding that of cisgender individuals and closely linked to stigma, discrimination, and transphobia rather than gender identity itself. There is an urgent need to develop interventional studies, alongside depathologizing and respectful approaches, to effectively address substance use, mental health, and HIV prevention among this population.