We examined alcohol use and harms, and their interrelations among cisgender and transgender college students. We conducted a secondary analysis using a U.S. sample of 4-year-college students (n = 242,624; = 20.24, = 1.67; 12.31% Hispanic/Latinx and 62.11% non-Hispanic/Latinx White, 3.99% Black, 11.88% Asian or Pacific Islander,0.37% American Indian, Alaskan Native or Native Hawaiian, 9.35% Multiracial/ethnic/other). These outcomes were compared between cisgender women (68.53%) and cisgender men (29.27%), transgender men (0.91%), transgender women (0.23%), and nonbinary students (1.06%): level (number of drinks) of recent alcohol use, frequency of binge drinking (≥ 5 drinks) in the past 2 weeks, and occurrence and count of harms while drinking in the past year. Gender differences in the association between drinking level and consequences were also examined. Cisgender women were the reference group for all of the comparisons. Cisgender men reported less occurrence of regret, sex without their consent, and unprotected sex when drinking, but the greater occurrence of injury and trouble with the police. Transgender women and nonbinary individuals reported lower odds of regret and unprotected sex when drinking. Transgender men and nonbinary individuals reported increased odds of sex without their consent when drinking. All transgender subgroups reported increased odds of suicidal ideation when drinking. Finally, associations between the level of recent drinking and odds of experiencing harms differed by gender identity. Patterns of alcohol use, consequences, and their interrelationship differed for cisgender men, transgender women and men, and nonbinary individuals relative to cisgender women. There is a need for gender-inclusive prevention for alcohol harms among students. (PsycInfo Database Record (c) 2022 APA, all rights reserved).