BACKGROUND: Transgender individuals are more likely to experience social and economic barriers to health and health care, and have worse mental health outcomes than cisgender individuals. Our study explores variations in mental health among minority genders after controlling for sociodemographic factors. MATERIALS AND METHODS: Multistate data were obtained from the 2014 to 2016 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. Data were included from respondents who were asked whether they identified as transgender, and if so, as male-to-female (MTF), female-to-male (FTM), or gender nonconforming. Frequent mental distress (≥14 days in the last month of "not good" mental health) was the primary outcome of interest. Analysis was performed using design-adjusted Chi-square tests and multivariable logistic regression models of frequent mental distress with gender identity as the independent variable of interest. RESULTS: Of 518,986 respondents, 0.51% identified as transgender. Higher rates of frequent mental distress were found between FTM (24.7% [18.5-32.3]) and gender nonconforming populations (25.4% [18.7-33.5]), compared with the MTF population (14.2% [10.9-18.3]). After controlling for sociodemographic factors, non-transgender female (adjusted odds ratio [aOR] 1.39 [confidence interval, CI 1.32-1.46]), FTM (aOR 1.93 [CI 1.26-2.95]), and gender nonconforming (aOR 2.05 [CI 1.20-3.50]) identities were associated with increased odds of frequent mental distress compared with non-transgender males. CONCLUSIONS: Our findings suggest differences in the mental health of transgender and non-transgender individuals, and between gender minorities within transgender population. The differences persist after controlling for sociodemographic factors. Our results suggest that considering the spectrum of minority genders within the transgender population may be important in understanding health outcomes.