Seahorses (Hippocampus spp.) are sold primarily for traditional medicine (TM) uses in Southeast Asia. Although Malaysia is reportedly an important global seahorse exporter, documentation on the current extent of seahorse catch and trade of seahorse-based TM within the country is limited. This study aimed to quantify patterns of seahorse bycatch, gear-specific biological parameters of caught seahorses, and trade characteristics in Malaysia. Questionnaire-based fisher and TM surveys were administered nationwide from March 2021 to March 2023. Seventy-one percent of fisher respondents (612 out of 860) reported catching seahorses, with gill or drift net fishers (73 %) more likely to have caught seahorses than trawlers (12 %). Significant spatial differences in species composition was observed between Peninsular Malaysia and Malaysian Borneo (Sabah state). The total estimated annual seahorse catch within Malaysia was approximately 3376 kg per year, with 77 % of the catch attributed to gill or drift nets and 23 % to trawling operations. Almost half (40 %) of traditional Chinese medicine (TCM) practitioners/ traders (n = 138), 3 % of Malay TM practitioners (n = 3), and 88 % of other TM traders (n = 7) reported selling seahorse species. This study is one of the first to quantify the often overlooked but critical contribution of small-scale fisheries, especially gill and drift nets, towards seahorse bycatch. The current supply volume and selling price of seahorses were observed to be relatively high, while the present-day demand was reportedly low. Almost half of TCM practitioners/ traders interviewed were still actively selling seahorses, indicating that there is still considerable demand. To ensure the sustainability of seahorse populations in Malaysia, efforts in both small-scale and trawl fisheries must be reduced while strictly enforcing seahorse trade regulations.