Two-Spirit, gay, bisexual, transgender and queer (2SGBTQ) men’s suicidality in Canada: A Scoping Review

Abstract

Suicide is a leading cause of death in Canada, with men being three times more likely to die from suicide compared with the rest of the population. Among Canadian men, those who are Two-Spirit, gay, bisexual, transgender, and queer (2SGBTQ) are disproportionately impacted by suicidality. Drawing on this growing public health crisis, this current scoping review focuses on Canadian-based 2SGBTQ men to address the research question: What is known about Canadian-based Two-Spirit, gay, bisexual, transgender, and queer (2SGBTQ) men’s experiences with suicidality? Keywords related to “2SGBTQ men” and “suicidality” were searched across five bibliographic databases to derive 25 articles for analysis. Three thematic findings were generated: (a) Methodological Approaches, (b) Social Identities and Stigma, and (c) Psychosocial Health Issues. First, we trace how the study designs, data sources, and sampling methods used in research influence how we know about 2SGBTQ men’s suicidality. Second, we report on anti-gay, anti-trans, and HIV stigma as characterizing the diverse associations between 2SGBTQ men’s multiple social identities and their suicidality risk. Third, we detail how psychosocial health issues, including mental illness, financial precarity, and substance use, exacerbate social stresses and related risks of suicidality for 2SGBTQ men. These findings map understandings about how suicide risk diversely manifests among subgroups of Canadian-based 2SGBTQ men and interconnections between 2SGBTQ men’s social identities, stigma, and their psychosocial health issues. We draw on these learnings to recommend future research priorities regarding 2SGBTQ men’s suicidality, alongside opportunities to advance knowledge to inform targeted suicide prevention interventions.

Introduction

Background

In Canada, suicide is a leading cause of death, with an average of 12 people dying by suicide daily, and another 200 attempting suicide (Government of Canada, 2023). Suicidality encompasses suicidal ideation, plans, and attempts (Winstanley, 2020). Approximately 12% of Canadians have had suicidal ideation in their lifetime, with 4.2% making suicidal plans and 3.1% attempting suicide (Government of Canada, 2023). Among Canadian men, suicide rates are approximately three times higher compared with Canadian women across all age groups, and the incidence increases with age—from 7.4 suicide deaths per 100,000 Canadian men aged 10 to 19 years old to 25.9 suicide deaths per 100,000 Canadian men aged 50 to 64 years old (Government of Canada, 2023). In distilling key factors influencing Canadian men’s suicide risks, a scoping review indicated the role of men’s specific occupation, age, and health inequities (Oliffe et al., 2021). Specifically, being Indigenous, gay, middle-aged, homeless, and/or a military veteran were discussed in relation to heightened risk for suicidality among men.

2SGBTQ Men’s Suicide and Suicidality in Canada

While suicide remains one of the leading causes of death for Canadian men, gay, and bisexual men experience a higher risk of suicide mortality compared with heterosexual men (Mathy et al., 2011; Plöderl et al., 2013), with the broader population of Two-Spirit (defined as Indigenous peoples of North and Central America (Turtle Island) whose sexual orientation, gender, and/or spiritual identities comprise both feminine and masculine spirits (Native Women’s Association of Canada, 2024)), gay, bisexual, transgender, and queer (2SGBTQ) men being disproportionately impacted by suicidality (Ferlatte et al., 2020; Hottes, Gesink, et al., 2016; Oliffe et al., 2021; Peter & Taylor, 2014; Polonijo et al., 2022; Stinchcombe & Hammond, 2021). Within the 2SGBTQ men population, suicidality rates also differ, with Two-Spirit/Indigenous sexual minority men (Polonijo et al., 2022), men living with human immunodeficiency virus (HIV) (Ferlatte et al., 2017, 2022), and men who are socioeconomically disadvantaged experiencing elevated suicidality risk (Ferlatte et al., 2017; Ferlatte, Salway, Hankivsky, et al., 2018; Kundu et al., 2022). As reported in a meta-analysis study, Two-Spirit, gay, and bisexual men are two to five times more likely to report a suicide attempt in their lifetime compared with heterosexual men (Hottes, Bogaert, et al., 2016). Another study that explored suicide and HIV as leading causes of death among gay and bisexual men (GBM) also reported that suicide has become the primary cause of premature mortality among GBM (Hottes et al., 2015). Scant evidence reports suicidality among transgender and other queer men, but studies with transgender and gender minority individuals (inclusive of but not limited to transgender and queer men) indicated transgender individuals were twice as likely to attempt suicide compared with cisgender people (Bockting et al., 2005), with close to 40% having attempted suicide at least once in their lives (Marshall et al., 2016).

The inequitable burden of suicidality and suicide among 2SGBTQ men highlights a growing public health crisis in Canada, especially as it remains the only G7 nation without a national suicide prevention policy (Olson, 2016). Policy is vital in providing a federal roadmap for addressing suicide among diverse equity-owed populations, including 2SGBTQ men, and for informing mental health care systems and population-tailored mental health programs (World Health Organization, 2014). The impact of suicide goes beyond the deceased; for every person who dies from suicide, approximately seven to 10 loved ones experience severe and significant emotional or mental health distress (Government of Canada, 2023). Suicide also invokes significant economic burdens, with every suicide death estimated to cost more than $1,000,000 in terms of lost productivity and health care costs to Canada (SMARTRISK, 2009).

Taken together, the social and economic burdens of suicidality among 2SGBTQ men in Canada warrant a focused synthesis of relevant empirical literature, above all to distill key findings that will inform future research and targeted suicide prevention efforts within this group.

Method

Design

Guided by the research question “What is known about Canadian-based Two-Spirit, gay, bisexual, transgender, and queer (2SGBTQ) men’s experiences with suicidality?” a scoping review was conducted to summarize and synthesize key findings related to Canadian-based 2SGBTQ men’s experiences with suicidality. Drawing on Arksey and O’Malley’s (2005) methodological framework for conducting scoping reviews, with further guidance by Levac et al. (2010), five steps were followed: (a) identifying the research question, (b) searching and retrieving relevant studies, (c) selecting studies that fulfilled all inclusion criteria, (d) extracting and charting findings in a table, and (e) collating, summarizing, and reporting the findings.

Search Strategy

Five electronic bibliographic databases, (a) MEDLINE (Ovid), (b) Web of Sciences, (c) EMBASE (Ovid), (d) PsycINFO, and (e) CINAHL, were searched. Medical Subject Headings (MeSH) terms for two concepts—2SGBTQ men and suicidality—were combined with Boolean operators to obtain a large yet focused selection of relevant articles. The MeSH search terms included suicid*, suicid* ideation, suicid* attempt, suicid* planning combined using “AND” with gay or bisexual*, homosexual*, LGBT*, Two Spirit, queer, sexual* minorit*, gender minorit*, transgender*. Hand search of the reference lists of the retrieved literature was also conducted to identify eligible empirical papers that were omitted from the bibliographic database search.

Study Selection

Limiting the search to English-language articles published between January 2013 and December 2024 inclusive, a total of 4,511 articles were obtained and exported to Covidence (https://www.covidence.org/)—an online scoping review management software. Herein, 1,330 duplicate articles were removed automatically through Covidence’s built-in deduplication tool, and 40 duplicate articles were manually removed. The titles and abstracts of the remaining 3,141 articles were screened by the lead author, and articles were excluded if they (a) were not peer-reviewed empirical published articles (e.g., dissertations, commentaries); (b) addressed mental health with no direct connections to suicidality; (c) focused solely on medically assisted suicide, suicide fatalities, and/or neurological/brain chemistry pertaining to suicide; (d) did not focus on Canadian sample populations; and (a) only had abstracts available. The lead author reviewed the full texts of 83 articles, with 25 meeting the inclusion criteria of (a) including Canadian-based 2SGBTQ men and (b) focusing on suicidality including suicidal ideation, plans and/or attempts (see Figure 1 for PRISMA flowchart).

Figure 1.

PRISMA Flowchart: Scoping Review on 2SGBTQ Men’s Experiences of Suicidality in Canada

Data Extraction

The 25 articles were read and re-read in full before the data were subsequently extracted and charted into a table on Microsoft Excel. The details of each study were documented including authors, year, study title, aims, research design and methods, study sample, and main findings (see Table 1). Among the studies included, 10 focused solely on gay, bisexual, straight, or other men who have sex with men, while 15 included mixed-gender samples that disaggregated findings for 2SGBTQ men. Geographically, 15 studies had a Canada-wide sample; seven studies sampled within British Columbia, one study included participants from central Canada, and one included participants from Ontario and Quebec. In charting the studies, findings were compared and categorized into descriptive label codes based on preliminary interpretations of Canadian-based 2SGBTQ men’s experiences of suicidality. In answering the research question, the data were further reviewed and compared to derive tentative categories and three thematic findings: (a) Methodological Approaches, (b) Social Identities and Stigma, and (c) Psychosocial Health Issues.

Table 1.

Matrix of Studies (N = 25) Included in Scoping Review on 2SGBTQ Men’s Experiences of Suicidality in Canada

Author(s), year	Article title	Study aim(s)	Research design and methods	Study sample	Main findings
Ferlatte et al. (2015)	Suicide-related ideation and behavior among Canadian gay and bisexual men: a syndemic analysis	To understand the factors that influenced suicide-related ideation and behaviors, and generate targeted suicide prevention strategies for Canadian gay and bisexual men.	Quantitative, using cross-sectional survey	Gay, bisexual, straight and other men in Canada	Approximately half reported lifetime experience of suicidal ideation, six times higher than Canadian heterosexual men, while above 12% have attempted suicide in their lifetime. With each added form of marginalization that gay and bisexual men experience such as physical violence and workplace discrimination, odds of suicidal ideation and attempt increase between two to four times more. The odds of having suicidal ideation and attempt also increase with the number of psychosocial issues that men face such as depression, anxiety, or living with HIV.
Ferlatte, Oliffe, et al. (2018)	Suicide prevention from the perspectives of gay, bisexual and Two-Spirit men	To garner perspectives on gay, bisexual and Two-Spirit men’s (GB2SM) suicide, and inform targeted programs and policies to prevent suicide in their communities	Qualitative, photovoice methods	GB2SM with previous experiences of suicidality, or have lost a fellow GB2SM to suicide	Key considerations for GB2SM’s suicide prevention: (a) homophobia and biphobia manifest to increase GB2SM’s suicide risks; (b) GB2SM need to be given accessibility to gender-affirming counseling services that are affordable, safe, and compatible; (c) peer support and community connection are important to help GB2SM cope with suicidality; and (4) fostering creative and cultural resilience, reflected by Indigenous men’s practices of their Indigenous cultures can help GB2SM deal with suicidality.
Ferlatte, Oliffe, et al. (2019)	Using photovoice to understand suicidality among gay, bisexual and Two-Spirit men	To provide insights into what drives suicidality from the perspectives of gay, bisexual and Two-Spirit men (GB2SM).	Qualitative, photovoice methods	GB2SM with previous experiences of suicidality	Violent and challenging childhoods associated with appearing too feminine, loss of Indigenous cultural identity and toxic masculinity impacted GB2SM’s self-worth and safety, hence influencing their suicidality. Underemployment, financial precarity, lack of belonging and isolation characterized by experiences of multiple minority stress and adherence to traditional masculine norms also influenced their suicidality.
Ferlatte, Salway, Hankivsky, et al. (2018)	Recent suicide attempts across multiple social identities among gay and bisexual men: an intersectionality analysis	To identify how recent suicide attempts are distributed and influenced by multiplicative axes of social identity among gay and bisexual men.	Quantitative, cross-sectional survey	Canadian gay and bisexual men who attempted suicide in the past year	Men with the following demographic characteristics had increased odds for self-reported suicide attempts: (a) not having a university degree, (b) not making more than $30,000 (within which, those without a university degree here have higher odds of self-reported suicide attempts compared with those with a university degree), and (c) being a bisexual man partnered with a man.
Ferlatte et al. (2017)	Stigma and suicide among gay and bisexual men living with HIV	To detail suicidal ideation and attempts among gay, bisexual and men who have sex with men (GBMSM) living with HIV, and the extent these experiences were associated with enacted HIV stigma.	Quantitative, cross-sectional survey	GBMSM living with HIV (n = 67)	Gay, bisexual and other men (GBM) living with HIV had higher odds of suicidal ideation and attempt compared to GBM who were not living with HIV. The more forms of HIV stigma GBM living with HIV faced such as sexual rejection, social exclusion, verbal abuse and physical abuse, the higher their odds of reporting suicidal ideation, and attempt.
Kundu et al. (2022)	Correlates of past year suicidal thoughts among sexual and gender minority young adults: a machine learning analysis	To analyze the risk of past year suicidal thoughts among Canadian 2SLGBTQI+ young adults, and examine the relative importance, interactions and intersectionalities of relevant sociodemographic, health and other factors associated with the risk of suicidal thoughts.	Quantitative, cross-sectional survey	2SLGBTQI+ young adults in Canada including 28% of self-identified men in the sample	Sixty-one percent reported having suicidal thoughts within the last 12 months. This odds of having suicidal thoughts was particularly high for those who sought for help since the start of the COVID-19 pandemic, rated their mental health status as poor or fair, were insulted by adults or parents since childhood, heard that identifying as 2SLGBTQI+ is not normal, were older aged, experienced depression or anxiety more than once a day in the past week and pretended to identify as straight or cisgender to be accepted by others
Oliffe et al. (2021)	Segmenting or summing the parts? A scoping review of male suicide research in Canada	To explore key findings in Canadian suicide research among male subgroups, to inform suicide prevention efforts	Scoping review	Papers published in English between 2009 to 2020 inclusive, and focused on suicide among Canadian boys and men	Sexual minority men had higher odds of suicidality compared with heterosexual men. Among sexual minority men, those who used tobacco, living with HIV, had low income, had no tertiary education, and identified as trans were more likely to experience suicidal ideation or attempt. Other stressors that underpin SMM’s suicidality include social exclusion, lack of belongingness, violence, homophobia, classism and racism.
Polonijo et al. (2022)	Trends and disparities in suicidality among heterosexual and sexual minority/Two-Spirit Indigenous adolescents in Canada	To identify 20-year time trend in suicidality (including testing whether sexual orientation-based inequalities have changed over time) and document suicidality disparities for heterosexual and sexual minority/Two-Spirit Indigenous adolescents in British Columbia.	Quantitative, repeated cross-sectional survey	Two-Spirit/Indigenous adolescents	Over 20 years, prevalence of suicidal ideation and attempt among Two-Spirit/sexual minority Indigenous boys is about two to five times higher than that of heterosexual Indigenous boys. In addition, odds of suicidal ideation and attempt for Two-Spirit/sexual minority Indigenous boys is higher between 2008 and 2018 than that of heterosexual boys. Bullying, victimization, violence and family rejection accounts for disparities in suicidality, and further compounded by stigma, discrimination and barriers to health care access.
Saewyc et al. (2020)	The link between LGBTQ-supportive communities, progressive political climate, and suicidal behavior among sexual minority adolescents in Canada	To systematically characterize LGBTQ-supportive environments and examine their influences on suicidal behavior among sexual minority youth.	Quantitative, cross-sectional survey	Self-identified lesbian, gay, bisexual and mostly heterosexual students in Grades 8 to 12 from British Columbia public schools	More than one third of adolescent sexual minority boys reported suicide ideation, and more than 10% of them reported suicide attempts. LGBTQ-supportive communities and progressive political climates were not protective of sexual minority boys against suicidality but were protective for sexual minority girls.
Salway & Gesink (2018)	Constructing and expanding suicide narratives from gay men	To expand contemporary narratives related to gay suicide, by documenting stories of gay men who attempted suicide as adults	Qualitative, narrative research	Self-identified gay men	Pride narrative is characterized by resistance to connect sexuality and suicidality, but in that process discovering that concealment of sexual identity influences suicide risk, and identity acceptance aid in reducing that risk. Trauma and stress narrative elaborate how participants manage and accumulate stress that increase their risk for suicide, and the coping strategies they have identified to mitigate this suicide risk. Memorial narrative revolved around the establishment and embracing a permanent sexual minority identity—one that typically starts from childhood. Outing narrative speaks to the injustices associated with surveillance and entrapment of homosexual people in the past, and the resilience that emerged in mitigating their suicide attempts that resulted from these injustices. Last, post-gay narrative explains the social isolation and loneliness that impact older gay men as a result of erasure from modern gay movements, and the risk this imposes on their suicide vulnerabilities.
Salway, Gesink, et al. (2018)	Evidence of multiple mediating pathways in associations between constructs of stigma and self-reported suicide attempts in a cross-sectional study of gay and bisexual men	To (a) develop a measurement model of sexual minority stress that includes constructs of anticipated prejudice and concealment of sexuality, (b) use structural equation modeling to assess the magnitude of associations between minority stress constructs and suicide attempts, and (c) look for evidence suggestive of mediation of these associations by commonly studied psychosocial causes of suicide.	Quantitative, cross-sectional survey	Canadian residents who identified as men, transgender, genderqueer, Two-Spirit or other	3.4% gay and bisexual men reported suicide attempts in the past 12 months, where enacted stigma was associated with approximately 50% of all suicide attempts. Anticipated prejudice on the other hand was associated with depression and social isolation, both of which were also associated with suicide attempts. Concealment of sexual identity was negatively associated with depression, hence negatively associated with suicide attempts, but it is positively associated with social isolation. These different associations between antigay stigma constructs and suicide attempts suggest a combination of different strategies to prevent suicide among gay and bisexual men.
Salway et al. (2020)	Prevalence of exposure to sexual orientation change efforts and associated sociodemographic characteristics and psychosocial health outcomes among Canadian sexual minority men	To describe the prevalence, social-demographic correlates, and health consequences of sexual orientation change effort (SOCE) among Canadian sexual minority men based on a large community-based survey	Quantitative, cross-sectional survey	Gay, bisexual, and other sexual minority Canadian men	3.5% of gay, bisexual and other sexual minority men have been exposed to sexual orientation change efforts. This exposure was higher among gay men compared with bisexual men, among trans men compared with cis men, among those who were out of the closet compared with those who were not, among Indigenous men and other racial minority men compared with White men, and among those who were low income compared with those with a higher income. Among those who were exposed to sexual orientation change efforts (SOCE), almost 70% experienced suicidal ideation and close to 30% attempted suicide.
Heinz & MacFarlane (2013)	Island lives: A trans community needs assessment for Vancouver Island	To generate a descriptive analysis of the needs of trans individuals and communities in Vancouver Island	Quantitative, cross-sectional survey	Transgender participants with 43% identified as transmasculine.	Above 70% of all those who considered suicide attributed it to being trans, and 15% declared a mental health condition. Among transmasculine people in the sample, 11% had only considered suicide, whereas 17% had actually attempted suicide.
Salway, Ferlatte, et al. (2018)	Healthcare engagement among gay and bisexual men with recent suicide ideation or attempts	To characterize Canadian gay and bisexual men with history of suicidal ideation or attempt’s patterns of health care utilization, and discussion of suicide, depression and substance use with health care providers.	Quantitative, cross-sectional survey	Canadian gay and bisexual men with history of suicidal ideation or attempts	In the past 12 months, 19% of men in the sample reported suicidal ideation or attempt, with 38% discussing suicide with a health care provider. Older men (aged 50+) were more likely to engage with a provider, and those who’d previously attempted suicide and connected with a provider right after were more likely to engage a provider now regarding mental health concerns compared to those with no previous history of suicide attempt. Men with no access to mental health services, have no family doctor and are not out about their sexuality to their providers are less likely to discuss mental health concerns with their providers. Having larger support groups is positively associated with mental health service engagement.
Veale et al. (2017)	Mental health disparities among Canadian transgender youth	To assess the prevalence of mental health concerns among transgender youth in Canada and make comparisons with population-based estimates.	Quantitative, cross-sectional surveys	Transgender youth from across Canada with 39% being transgender boys/men	The prevalence of seriously considering and attempting suicide were not significantly different between transgender boys/men compared with transgender girls/women and nonbinary youth.
Ferlatte, Salway, Trussler, et al. (2018)	Combining intersectionality and syndemic theory to advance understandings of health inequities among Canadian gay, bisexual and other men who have sex with men	To apply the intersectionality framework to identify which subgroups of Canadian-based GBM are at an increased risk of experiencing a syndemic	Quantitative, cross-sectional survey	Canadian gay and bisexual men who were either tested negative for HIV or never got tested for HIV	Suicidality was highly correlated with unprotected anal sex with a partner whose STI status was unknown. The odds of suicidality were also higher among single or male-partnered gay men compared with men who have sex with men (MSM) who had a female partner, but no difference compared to single or male-partnered bisexual men. Compared with Caucasian men, Asian men are less likely to report suicidality, but there are no differences with men of other racial identities. Gay-identifying Indigenous men were more vulnerable to experiencing syndemics of psychosocial issues which includes suicidality.
Hottes, Gesink, et al. (2016)	Concealment of sexual minority identities in interviewer-administered government surveys and its impact on estimates of suicide ideation among bisexual and gay men	To investigate the impact of concealment of sexual identity in population surveys on estimates of suicide ideation for Canadian gay and bisexual men	Quantitative, cross-sectional survey	Gay and bisexual men in Canada	Compared with heterosexual men, gay and bisexual men had higher odds of suicidal ideation, with the odds being a lot higher for bisexual men compared with gay men. Concealment of sexual identity had little effects on suicidal ideation estimates for gay men, but more pronounced for bisexual men’s suicide ideation estimates—47% of bisexual men who reported suicidal ideation were more willing to report their sexual identity to Statistics Canada compared with 34% of bisexual men who reported no suicidal ideation. Similarly, 88% of gay men who reported suicidal ideation were more willing to report their sexual identity to Statistics Canada compared with the 84% of gay men who reported no suicidal ideation
Ferlatte et al. (2020)	Suicidality, maladaptive externalizing behaviors, and sexual orientation: results from an online representative sample of Canadian men	To examine the relationships between sexual orientation, maladaptive externalizing behaviors and suicide in an online, nationally representative sample of Canadian men, and to identify to which degree maladaptive externalizing behaviors are associated with increased suicide risks among gay, bisexual and heterosexual men	Quantitative, cross-sectional survey	Gay, bisexual, and straight Canadian men with 7.6% being either gay or bisexual	Gay and bisexual men were twice as likely as being identified as at risk for suicide than those who identified as heterosexual or straight. Maladaptive behaviors such as drug and alcohol misuse, angry and aggressive behavior and risk-taking behavior were more predictive of heterosexual men’s suicide risk status, but less predictive for gay and bisexual men.
Ferlatte et al. (2024)	Self-perceived reasons for suicide attempts in sexual and gender minorities in Canada	The generate insights on the diverse factors and reasons that have influenced sexual and gender minorities’ suicidality in Canada.	Quantitative, cross-sectional survey	Sexual and gender minority individuals in Canada, which included sexual and gender minority men	Among cis-gendered sexual minority men, the percentage of those who have attempted suicide at least once compared with those who attempted suicide multiple times was approximately equal. However, among transgender men, the percentage of trans men who has attempted suicide multiple times is approximately triple the percentage of those who attempted it only once. Transgender men attribute their suicide attempts to minority stress related to transgender and gender identity, while cis gender sexual minority men attribute their suicide attempt to minority stress related to their sexual orientation.
Ferlatte et al. (2022)	Understanding stigma and suicidality among gay men living with HIV: A photovoice project	To determine the connections between stigma, having HIV and suicidality among gay men living with HIV	Qualitative, photovoice methods	Self-identifying gay men living in HIV in British Columbia	All of the participants in the study had suicidal ideations, with 15 having made suicide plans. Eight participants attempted suicide prior to their HIV diagnosis, whereas nine attempted after being diagnosed with HIV. HIV stigma underpinned experiences of rejection and abandonment, which subsequently predisposed the participants to increased risks for suicidality. Lack of social support was described as one of the primary factors that heightened suicide risk for the participants.
Liu et al. (2023)	Suicidality and protective factors among sexual and gender minority youth and adults in Canada: a cross-sectional, population-based study	To make estimations about the prevalence and disparities related to suicidality and protective factors among sexual and gender minority youth and adults in Canada.	Quantitative, cross-sectional survey	Sexual and gender minority youth and adults in Canada, which included gay, bisexual and other sexual minority men.	Prevalence of suicidal ideation, planning and attempt was significantly higher among bisexual/pansexual men compared with gay men and other sexual minority men. In terms of the overall sample of sexual and gender minority people, suicidal ideation prevalence increased between 2015 to 2020. Similarly, drawing on the entire sample—not just gay, bisexual and other sexual minority men, it was established that having access to healthcare resources and social support was associated with decreased suicidal ideations.
Peter & Taylor (2014)	Buried Above Ground: A University-Based study of risk/protective factors for suicidality among sexual minority youth in Canada	To investigate the differences in suicidality between lesbian, gay and bisexual (LGB) and heterosexual university students, and identify risk and protective factors associated with their experiences of suicidality.	Quantitative, cross-sectional survey	LGB and heterosexual university students	Gay and bisexual men are almost two times more likely to attempt suicide or experience suicidal ideations compared with heterosexual peers. For the overall sample of LGB students, depression is strongly co-related with suicidality. In addition, having a higher socioeconomic status is also associated with higher suicidality among LGB students—not just gay and bisexual men.
Peter et al. (2017)	Trends in suicidality among sexual minority and heterosexual students in a Canadian population-based cohort study	To explore the trend in suicidal ideations and attempts as well as its risk factors between 1998 and 2013 among sexual minority and heterosexual students.	Quantitative, repeated cross-sectional survey	Self-identified lesbian, gay, bisexual and mostly heterosexual students in Grades 7 to 12 from British Columbia public schools	Among gay boys, there was an overall trend reduction in suicidal ideation and attempts over time, but for bisexual boys, there was an increase in suicidal ideation and attempt trend over time. Compared with heterosexual boys, gay, and bisexual boys collectively still had higher odds for suicidal ideation and attempts, with bisexual boys having the highest odds for both.
Ferlatte, Salway, Rice, et al. (2019)	Perceived barriers to mental health services among Canadian sexual and gender minorities with depression and at risk of suicide	To identify mental health service barriers across subgroups of sexual and gender minority people who face depression and are at risk for suicide.	Quantitative, cross-sectional survey.	Sexual and gender minority people in Canada, including cisgender and transgender sexual minority men.	Among transgender and cisgender sexual minority men who have depression, a higher percentage is at risk for suicide compared with those who are not. Among transgender men at risk for suicide, a higher percentage have depression compared with those who do not. However, for cisgender sexual minority men who are at risk for suicide, a higher percentage do not have depression compared with those who do. Over 50% and 60% of cisgender and transgender men cannot afford the financial cost associated with seeking with mental health care. The percentage of transgender men who are concerned about not finding a LGBTQ+-friendly is double the percentage of cisgender sexual minority men who are concerned.
Stinchcombe & Hammond (2020)	Sexual orientation as a social determinant of suicidal ideation: a study of the adult life span	To investigate the lifetime prevalence of suicidal ideation among lesbian, gay, and bisexual people compared with heterosexual people in a national Canadian sample.	Quantitative, cross-sectional survey.	Canadian lesbian, gay, bisexual and heterosexual people aged 15 and above, including gay and bisexual men.	The prevalence of suicidal ideation among bisexual men is higher than gay men (the highest being during early midlife for bisexual men, which is also when it is the lowest for gay men). However, compared with heterosexual peers, gay and bisexual men still had a higher prevalence of suicidal ideations.

Results

Theme 1. Methodological Approaches

Most studies in this review used cross-sectional, quantitative research approaches (and drew on secondary data analysis) to report the prevalence of and factors linked to 2SGBTQ men’s suicidality. Photovoice—a community- and arts-based research approach—was the primary method used in the qualitative studies included in this review.

Quantitative Studies

Eighteen studies used observational, cross-sectional surveys (Ferlatte et al., 2015, 2017, 2020, 2024; Ferlatte, Salway, et al., 2019; Ferlatte, Salway, Hankivsky et al., 2018; Ferlatte, Salway, Trussler, et al., 2018; Heinz & MacFarlane, 2013; Hottes, Gesink, et al., 2016; Kundu et al., 2022; Liu et al., 2023; Peter & Taylor, 2014; Saewyc et al., 2020; Salway et al., 2020; Salway, Ferlatte, et al., 2018; Salway, Gesink, et al., 2018; Veale et al., 2017; Stinchcombe & Hammond, 2021), with two studies specifically using repeated cross-sectional surveys spanning 15-year (Peter et al., 2017) and 20-year (Polonijo et al., 2022) periods with different sample populations. Fourteen studies comprised secondary analyses of existing surveys. Of these, seven studies used Sex Now (SN) survey data, a Canadian-wide cross-sectional survey of GBM’s health developed by the Community-Based Research Center (CBRC) (Ferlatte et al., 2015, 2017; Ferlatte, Salway, Hankivsky, et al., 2018; Ferlatte, Salway, Trussler et al., 2018; Salway et al., 2020; Salway, Ferlatte, et al., 2018; Salway, Gesink, et al., 2018). In addition, three studies used data from the British Columbia Adolescent Health Survey’s (BC AHS) database, a province-wide survey administered to youth in Grades 7 to 12 in British Columbia (Peter et al., 2017; Polonijo et al., 2022; Saewyc et al., 2020). Two studies used data from different cycles of the Canadian Community Health Survey (CCHS)—a national, population survey on the health determinants of the Canadian population (Liu et al., 2023; Stinchcombe & Hammond, 2021).

Hottes, Gesink, et al. (2016) used a combination of surveys—the CCHS and Sex Now—whereas Kundu et al. (2022) conducted a secondary analysis of the LGBTQI2S+ Tobacco Project Survey database that was conducted among Canadian-based lesbian, gay, bisexual, trans, queer, intersex, Two-Spirit, and other (LGBTQI2S+) young adults aged 16 to 29.

Six studies collected primary data using tools that were adapted from other validated surveys or scales. Veale et al. (2017) collected primary data using the Canadian Trans Youth Health survey that was developed using questions from the CCHS and BC AHS, whereas Heinz and MacFarlane (2013) collected quantitative data on the social and health needs of transgender people in Vancouver Island using the Vancouver Island survey, which was adapted from the TransPULSE Ontario survey. With an overarching focus on the association between risk for suicidality and specific risk and/or protective factors for sexual and gender minorities, four studies collected primary data using unnamed surveys that were adapted from a combination of various scales, including the Suicide-Behaviours Questionnaire–Revised, Patient Health Questionnaire-9, Male Depression Risk Scale-22, Barriers to Access to Care Evaluation Scale, and Anxiety Control Questionnaire (Ferlatte et al., 2024; Ferlatte et al., 2020; Ferlatte, Salway et al., 2019; Peter & Taylor, 2014). Ten different survey tools were used across the quantitative studies. Eight of these surveys (Sex Now, LGBTQI2S+ Tobacco Project Survey, Canadian Trans Youth Health, Vancouver Island survey, Health and Well-Being Survey, three other unnamed surveys) used nonprobability convenience sampling to recruit participants, while the BC AHS and CCHS used cluster-stratified random sampling and stratified multistage sampling, respectively.

Qualitative Studies

Three qualitative studies conducted in-person, individual photovoice interviews where participants submitted and discussed photographs related to their suicidality (Ferlatte et al., 2022; Ferlatte, Oliffe, et al., 2018, 2019). Salway and Gesink (2018) conducted in-person narrative interviews where open-ended questions were used to prompt participants to narrate their experiences of suicidality throughout their lives. Across all four studies, participants were purposively sampled. In analyzing their findings, Ferlatte, Oliffe, et al. (2018) and Ferlatte, Oliffe et al. (2019) employed thematic analysis to distill key patterns in participants’ suicidality, whereas Salway and Gesink (2018) used dialogical narrative analysis to decipher participants’ construction of their experiences of suicidality. Ferlatte et al. (2022) drew on constant comparison analytics to compare and refine generated themes illustrating the connections between stigma, HIV, and suicidality among gay men living with HIV.

Constructs of Suicidality

Across all the articles, three different constructs of suicidality were explored—suicidal ideation, plans, and attempt. Twelve studies explored suicidal ideation and/or attempts as characterizing 2SGBTQ men’s suicidality, whereas six studies explored all three constructs—suicidal ideation, plans, and/or attempt(s). Comparing suicidal ideation and attempts, five studies reported that the number of men who experienced suicidal ideation was two to five times higher than those who attempted suicide (Ferlatte et al., 2015, 2017; Saewyc et al., 2020; Salway et al., 2020; Salway, Ferlatte, et al., 2018).

Theme 2. Social Identities and Stigma

The reviewed articles often reported interconnections between suicidality and 2SGBTQ men’s multiple (and intersecting) social identities, including being gay, bisexual or transgender, Two-Spirit/Indigenous, and/or living with HIV. These social identities and related forms of structural oppression predisposed 2SGBTQ men to stigmas including anti-gay, anti-trans, and HIV stigma, all of which influenced their experiences of violence, prejudice, and discrimination in ways that were depicted as exacerbating their suicidality risk.

Gay and Bisexual Men

Anti-gay stigma characterized by homophobia or biphobia impacted GBM. In most cases, anti-gay stigma manifested as either enacted stigma—experience of violence and discrimination by others, and/or anticipated stigma—feelings of distress and worry about potentially being stigmatized or discriminated against, leading to concealment of sexual identities and internalized homophobia (Salway, Gesink et al., 2018). Six studies reported that GBM who experienced enacted anti-gay stigma such as verbal, physical, or sexual violence had higher odds for suicidal ideation or attempt compared with heterosexual men (Ferlatte et al., 2015, 2020; Hottes, Gesink, et al., 2016; Salway et al., 2020; Salway, Gesink et al., 2018). Describing the synergistic production of social and health inequities, Ferlatte et al. (2015) also added that GBM’s odds for suicidal ideation and attempt increased with each added form of enacted anti-gay stigma including bullying and workplace discrimination. Distinguishing the difference between enacted and anticipated stigma among GBM, Salway, Gesink, et al. (2018) reported that enacted anti-gay stigma had greater association with suicidality compared with anticipated stigma. Three qualitative studies provided in-depth explanations about the connections between anti-gay stigma and suicidality, describing how homophobia/biphobia are entwined with mental health stigma to culminate in violent and challenging life circumstances for GBM, both in the context of their personal relationships with family and friends, and in society more broadly. In most cases, these influenced GBM’s social isolation/exclusion, amplifying their suicidality (Ferlatte, Oliffe, et al., 2018, 2019; Salway & Gesink, 2018).

Distinguishing between GBM, six studies reported that the likelihood for suicidality was higher for bisexual men compared with gay men (Ferlatte, Salway, Hankivsky, et al., 2018; Kundu et al., 2022; Hottes, Gesink, et al., 2016; Liu et al., 2023; Peter et al., 2017; Stinchcombe & Hammond, 2021). Stinchcombe and Hammond (2021) specified that bisexual men were more likely to report suicidal ideations during early midlife (aged 35–44 years old), which is also when gay men had the lowest odds of experiencing suicidal ideation. Attesting to this, Peter et al. (2017) reported an increasing overall trend of suicidality for bisexual boys (15 years old, on average) over a 15-year period but decreased for gay boys of similar age during the same time frame. Furthermore, Ferlatte, Salway, Hankivsky, et al. (2018) also specified that bisexual men partnered with a man had higher odds of attempting suicide compared with bisexual men who were partnered with a woman, with Ferlatte, Salway, Trussler, et al. (2018) reporting no statistically significant difference in odds for suicidality when this population was compared with single bisexual men.

Transgender Men and/or Transmasculine People

Five studies drew from a larger sample of sexual and gender minority people to describe patterns of suicidality among transgender men (individuals who self-identify as men, but were assigned female at birth) and other transmasculine people (transgender individuals who identify or express masculinity, but do not necessarily self-identify as men) (Ferlatte et al., 2024; Heinz & MacFarlane, 2013; Hottes, Gesink, et al., 2016; Kundu et al., 2022; Veale et al., 2017). Of these, three studies specifically identified anti-trans stigma as predisposing transgender men to suicidality (Ferlatte et al., 2024; Heinz & MacFarlane, 2013; Kundu et al., 2022). Heinz and MacFarlane (2013) reported that more than 65% (N = 15) of transmasculine people in their study had either considered or attempted suicide, with Ferlatte et al. (2024) reporting that transgender men are three times more likely to attempt suicide more than once in their lives. Veale et al. (2017) also reported that transgender men’s prevalence of suicidal ideation was five to eight times higher than the general male population, with a smaller percentage of transgender men aged 19 to 25 years old reporting suicidal ideations or attempts compared with transgender teenage boys aged 14 to 18 years old.

Two-Spirit/Indigenous and Racialized Boys and Men

Two-Spirit and/or Indigenous sexual minority boys and men’s experiences of suicidality were specifically analyzed in three studies (Ferlatte, Oliffe, et al., 2019; Ferlatte, Salway, Hankivsky et al., 2018; Polonijo et al., 2022). Polonijo et al. (2022) reported that overall, Two-Spirit and/or sexual minority Indigenous boys had approximately three to five times the odds of experiencing suicidal ideation compared with heterosexual Indigenous boys over a 20-year period. While not statistically significant, Ferlatte, Salway, Hankivsky, et al. (2018) also reported that Indigenous (referenced as Aboriginal in the original article) GBM had twice the odds of attempting suicide compared with Caucasian men in the study’s sample population. Delineating some of the factors that have characterized Two-Spirit men’s suicidality, Ferlatte, Oliffe et al. (2019) described Two-Spirit men’s experiences with residential schools and physical abuse for being gay as heightening their vulnerability and subsequent suicidality. Racialized 2SGBTQ men—defined as 2SGBTQ men of different ethnocultural and/or ancestral backgrounds and are non-White (Das Nair & Thomas, 2012; Layland et al., 2022)—were also included as a part of the sample population across most studies, yet only made up 12% to 30% of the total sample sizes. That said, only Ferlatte, Oliffe et al. (2019) explicitly reported Asian Canadian sexual minority men’s struggles to reconcile their racial and sexual identities due to sociocultural challenges as a factor that influenced their loneliness and vulnerabilities for suicide.

Living With HIV

Living with HIV also predisposed 2SGBTQ men to a higher likelihood for suicidality, with six studies reporting the interconnections between HIV stigma and social isolation, violence, and discrimination for 2SGBTQ men, ultimately increasing their odds for suicidal ideation and/or attempt (Ferlatte et al., 2017, 2022; Ferlatte, Oliffe, et al., 2019; Ferlatte, Salway, Hankivsky et al., 2018; Oliffe et al., 2021; Salway & Gesink, 2018). Three studies reported that gay or bisexual men living with HIV had higher likelihood of attempting suicide compared with HIV-negative men (Ferlatte et al., 2017; Ferlatte, Salway, Hankivsky, et al., 2018; Oliffe et al., 2021), with Ferlatte et al. (2017) specifying that the odds for suicide attempts were higher than suicidal ideation among GBM living with HIV. Herein, it was reported that HIV stigma underpinned the compounded effects of sexual rejection, social exclusion, and physical/verbal abuse among GBM living with HIV. These factors fuelled feelings of abandonment among GBM living with HIV, compounding experiences of social isolation and marginalization that amplified their suicidality (Ferlatte et al., 2022; Ferlatte, Oliffe, et al., 2019; Salway & Gesink, 2018).

Theme 3. Psychosocial Health Issues

The literature connected various psychosocial health issues to 2SGBTQ men’s suicidality, manifesting throughout their lives and into adulthood. Characterized by mental illnesses, financial precarity, and substance use, these psychosocial health issues were entwined with 2SGBTQ men’s social identities to further marginalize them and influence their suicidality risk.

Mental Illness

Ten studies reported depression/anxiety as characterizing 2SGBTQ men’s mental illnesses that are linked to their suicidality (Ferlatte et al., 2015, 2022, 2024; Ferlatte, Oliffe, Louie, et al., 2018; Ferlatte, Oliffe, et al., 2019; Ferlatte, Salway, et al., 2019; Ferlatte, Salway, Trussler, et al., 2018; Peter & Taylor, 2014; Salway & Gesink, 2018; Salway, Gesink, et al., 2018). Ferlatte et al. (2015) specifically reported the odds for suicidal ideation or attempts were approximately five times higher for GBM with depression, and between 1.6 and 2.8 times for those with anxiety. Distinguishing between transgender and cisgender men, Ferlatte, Salway, et al. (2019) reported that among transgender men at risk for suicidality, a higher percentage had depression compared with those who did not, which was the opposite for cisgender sexual minority men who are at risk for suicidality.

Financial Precarity

Two-Spirit, gay, bisexual, transgender, and queer (2SGBTQ) men’s financial precarity was characterized by un- or underemployment (Ferlatte, Oliffe, et al., 2019; Kundu et al., 2022), lack of higher education (Ferlatte, Oliffe, et al., 2019; Ferlatte, Salway, Hankivsky, et al., 2018; Kundu et al., 2022; Oliffe et al., 2021), homelessness (Ferlatte, Oliffe, et al., 2019; Polonijo et al., 2022), and an annual financial income of less than $60,000 (Ferlatte et al., 2017; Ferlatte, Salway, Hankivsky, et al., 2018; Kundu et al., 2022), all of which were associated with 2SGBTQ men’s suicidal ideations and/or attempts. Ferlatte, Salway, Hankivsky, et al. (2018) reported that among 2SGBTQ men who had annual income of $30,000 and below, those without higher education were five times more likely to attempt suicide compared with 2SGBTQ men who completed higher education. Consistently, these studies argued that socioeconomic inequities restricted 2SGBTQ men’s access to affordable and/or culturally competent mental health services, hindering opportunities to improve mental health and increasing suicide risk (Ferlatte, Oliffe, Louie, et al., 2018; Ferlatte, Oliffe, et al., 2019; Ferlatte, Salway, et al., 2019; Kundu et al., 2022; Polonijo et al., 2022). Interestingly, one study with a larger sample of LGBTQ university students that included GBM reported that having a higher socioeconomic status was positively correlated with suicidality (Peter & Taylor, 2014).

Substance Use

Alcohol and other substance use were occasionally associated with 2SGBTQ men’s suicidality. Kundu et al. (2022) reported that suicidal thoughts were prevalent among sexual and gender minorities who “misused” substances (over 40%). Ferlatte, Salway, Trussler, et al. (2018) also reported that the odds for suicidal ideation and/or suicide attempts were approximately 30% to 50% higher for GBM who used party drugs and/or binge drank alcohol. However, contrary to these findings, Ferlatte et al. (2020) found no statistically significant association between GBM’s maladaptive externalizing behaviors including substance use, sexual orientation, and their suicidality, a finding supported by Ferlatte et al. (2015) that reported the lack of significant association between the use of party drugs and GBM’s risks for suicidal ideations and/or attempts.

Discussion and Conclusion

Synthesizing the literature to map how and what is known about Canadian-based 2SGBTQ men’s experiences of suicidality, the insights garnered are discussed to inform future research and tailor suicide prevention services for 2SGBTQ men.

Quantitative studies included in this review relied heavily on cross-sectional study designs to helpfully describe the prevalence and correlations between different factors heightening 2SGBTQ men’s suicidality risk. Lacking are temporalities to indicate the direction and magnitude of these relationships (Wang & Cheng, 2020). Furthermore, given that suicidality often exists as a changing dynamic process characterized by one’s ambivalence for living or dying (Brown et al., 2005; Kovacs & Beck, 1977), cross-sectional studies limit insights to the shifts (and tailored temporal interventions) in 2SGBTQ men’s suicidality over time. The loss here are insights for and opportunities to develop primary suicidality prevention interventions for 2SGBTQ men, rather than just responding to their suicidality-related crises (secondary prevention; Gordis, 2013). Future research might advance the field by employing prospective and/or retrospective longitudinal study designs to report causative strengths and temporal changes in the relationship between 2SGBTQ men’s suicidality and their social identities and psychosocial health issues. The use of nonprobability convenience sampling in many of the reviewed studies is helpful in expediting cost-effective recruitment of 2SGBTQ men (Golzar et al., 2022). However, challenges for generalizing findings across and within subgroups of 2SGBTQ men, including racialized 2SGBTQ men is not possible. Past histories of mistreatment in research (Ellard-Gray et al., 2015) and the lack of conceptual clarity over how researchers might categorize and interpret racialized people’s identities and experiences (Outram et al., 2022) may have made racialized 2SGBTQ men harder to reach. That said, Waheed et al. (2015) suggest a few options for researchers to build cultural sensitivity in purposively sampling and establishing rapport with the racialized communities, through collaborations with community organizations and/or the appointment of culturally competent leaders who are sensitive to the community’s needs. Most qualitative studies in this review illustrated the value of utilizing photovoice—a community-based research method to bolster 2SGBTQ men’s agency for exploring and addressing their suicidality. Offering emancipative effects and easing 2SGBTQ men’s stress when talking about their experiences (Oliffe & Bottorff, 2007; Wang & Burris, 1997), photovoice methods can engage 2SGBTQ men as co-researchers in research that seek to sustainably address, rather than just theorize, their suicidality. Furthermore, with cost-effective options for virtual photovoice, studies sampling can be inclusive (Oliffe et al., 2023) enabling connectivities with 2SGBTQ men in flexible ways, transforming the use of participatory action research (Oliffe et al., 2024) to explore and address 2SGBTQ men’s suicidality.

Anti-gay stigma featured prominently as underpinning the violence and discrimination influencing 2SGBTQ men’s suicidality risk. This review’s findings resonate with recent studies reporting how anti-gay stigma can manifest throughout one’s life to influence their suicide risk (Marzetti et al., 2022; Tan et al., 2021). For instance, anti-gay stigma is linked to bullying and childhood sex abuse (Capaldi et al., 2024), workplace-based discrimination (Pellegrini et al., 2020; Tilcsik, 2011), and internalized self-hatred, all of which amplify GBM’s social isolation and thwarted belongingness, heightening their suicide vulnerabilities (Salway & Gesink, 2018). For transgender men, suicidality may additionally stem from anti-trans stigma and cisnormative pressures that perpetuate gender-based discrimination and violence, minority stress, and lack of trans-specific social support (Marzetti et al., 2022). Among bisexual men, numerous studies have attributed their heightened suicidality to biphobia—a form of prejudice toward bisexual people that is rooted in monosexism—the fundamental rejection of bisexual identities to preserve assumptions of binary sexual orientations (Ross et al., 2010). As a result, bisexual men may be somewhat invisible, producing unique stressors that influence their suicidality risk (Hottes, Gesink, et al., 2016). Beyond sexual orientation-based stigma, 2SGBTQ men living with HIV also have risks for suicidality amplified by HIV stigma, which persists despite advancements in HIV treatment and related community awareness and advocacy (Ford et al., 2022). In this context and considering the overall findings from the current study, we suggest that suicide prevention efforts ought to address compounding forms of stigma and the centrality of gender/sexuality in mitigating 2SGBTQ men’s suicidality risks.

The 2SGBTQ men’s psychosocial health issues including mental illnesses, financial precarity, and substance use routinely interconnect to influence their suicidality risk. Almost half the studies in this review reported associations between depression and anxiety and 2SGBTQ men’s suicidality. This is underscored by the disproportionate burden of depression among sexual and gender minorities (Government of Canada, 2024), and its role as a key risk factor for suicide (Lee et al., 2017). That said, while past evidence has described social isolation and disconnectedness/loneliness as precursors for depression (Santini et al., 2020), it is vital to acknowledge (and address) the structural determinants that prevent 2SGBTQ men from accessing mental health supports. Specifically, eight studies in this review reported connections between financial precarity (un- or underemployment, lack of higher education, homelessness, and earning low income) with 2SGBTQ men’s increased suicidality, with fives studies explicitly citing these inequities as barriers to accessing mental health care (much of which is paid for out of pocket or through private insurance in Canada (Lowe et al., 2024)). Herein, there are clear needs for policy to prioritize timely and equitable access to mental health care for 2SGBTQ men (and others), by funding no- and low-pay services with attention to the structural (and commercial) determinants of suicidality and related inequities among 2SGBTQ men. While substance use is correlated with 2SGBTQ men’s suicidality, seldom addressed were the complex spectrum of substance use among Canadian-based 2SGBTQ men, including how the sales and taxes of alcohol and other drugs operate within neoliberal Canada and its connections to 2SGBTQ men’s suicide risk. For instance, Gerrard et al. (2012) described African American participants’ use of substances as a way of coping with racial discrimination, and Goodyear et al. (2024) reported how substances were used as a survival tool for 2SLGTBQ+ youth in Canada, offering comfort and a sense of safety amid experiences of homelessness and structural violence. That said, while substance use can espouse some respite for 2SGBTQ men who grapple with stigma and other psychosocial health issues, the impulsivity and reduced inhibitions derived may also supress feelings of fear that were otherwise stopping the transition from suicidal ideation to attempts (Culbreth et al., 2021; Edalati et al., 2024). Future research and interventions might usefully explore the role of the structural determinants of health to dispense with inadvertently perpetuating lifestyle drift research that situates substance use in 2SGBTQ men as an entirely behavioral issue.

This scoping review is not without limitations. For one, while the description of Canadian-based 2SGBTQ men’s diverse social identities and psychosocial health issues may relate to 2SGBTQ men in other countries, the findings and recommendations are Canadian-specific, limiting transferability to countries with different sociocultural norms and legislations impacting sexual and gender minorities. This scoping review also did not evaluate and report the analytical rigor of the included studies, leaving opportunity for a systematic review or meta-analysis to provide additional insights on the reliability and quality of data pertaining to 2SGBTQ men’s suicidality.

Findings from this work have important implications for future research, including the need to employ study designs that will yield representative and temporal data on 2SGBTQ men’s suicidality. Insights from this scoping review also highlight the need to better attend to inequities by addressing stigma and other social and structural determinants of health related to 2SGBTQ men’s suicidality. Together, the insights and recommendations made here support the development and implementation of tailored, responsive, and upstream suicide prevention programs informed by research for and with 2SGBTQ men in Canada.