BACKGROUND: In the United States, only 15-20% of people with opioid use disorder (OUD) receive medications for OUD annually. Injectable opioid agonist treatment with hydromorphone (iOAT-H) is a novel approach that reduces non-prescribed opioid use. However, interest in iOAT-H among women, who face unique challenges in OUD treatment, may be different than men. This study evaluates women's attitudes toward iOAT-H, and gender disparities in OUD-related risks, exploring potential gender-specific treatment needs. We hypothesized that women would be less interested in iOAT-H than men given the disproportionate stigma women face in accessing OUD treatment. METHODS: This is a secondary analysis of a cross-sectional study of urban syringe service program participants. Participants self-reported interest in iOAT-H, which was assessed on a 4-point scale with 3 or 4 considered "interested." Participants also provided self-reported data on preferences for OUD treatment and their OUD-related risks, including frequency of drug use and injection practices. Descriptive statistics and comparative analyses were employed to explore gender differences. RESULTS: Of 108 participants, 31% were women and 69% were men with a mean age of 43.0 (SD ± 10.8). Almost all participants had severe OUD (98.1%) and had prior OUD care (96.3%). Most women (68%) and men (64%) reported interest in iOAT-H. For OUD treatment preferences, most women chose iOAT-H (56%), while men most commonly endorsed methadone treatment (42%) as their preferred option. Women had more OUD-related risks than men including injecting more times per day (5 vs. 3, p > 0.01) and injecting in public more often (24 vs. 7, p = 0.05) in the past 30 days. CONCLUSION: Interest in iOAT-H was high among women and men, but we found gender differences in OUD-related risks. This may reflect unmet needs among women who would potentially enter treatment with iOAT-H, but additional work is necessary to examine specific risks such as mental health, trauma exposure, and creating safe treatment spaces for women. Nonetheless, iOAT-H appeared acceptable to women in our sample, and many treatment-experienced people who inject drugs would prefer iOAT-H to other available OUD treatments.