Research demonstrates that transgender people face significant health disparities compared to their cisgender peers, experience harassment and mistreatment in health care settings, and that many health care facilities are ill-equipped to competently treat them. While there has been some evaluation of trans-inclusive services provided in large health care facilities, there has been no formal assessment of the competencies of college health care facilities to meet the needs of transgender students. A 43-item survey tool operationalizing the American College Health Association’s (ACHA) Guidelines for Trans-Inclusive College Health Programs was developed and sent to representatives of ACHA’s membership (n=1,005). The degree to which college health centers are meeting these 32 recommended guidelines was assessed. The data show that college health centers are overwhelming providing some degree of trans-inclusive health care and that the provision of such services varies greatly based on six institutional characteristics: control of institution (public vs. private); religious affiliation (yes vs. no); transgender-inclusive laws and policies by state (low inclusion vs. high inclusion); size of institution (<1000, 1000-4999, 5000-9999, 10000-19999, 20000+); locale (city, suburban, town, rural); and region (Northeast, Midwest, South, West). These findings are notable in that many college health centers are providing more trans-inclusive care than most large health care facilities and are positioned to be leaders in trans-inclusive health care. Despite the provision of such services on college campuses, transgender students still face significant health disparities compared to their cisgender peers and more research is needed to better understand what colleges and communities can do to improve their health outcomes.