Recent focus on the unique mental health needs of transgender and genderqueer (TGQ) individuals has shown an increased risk for mental health disorders, trauma, exposure, and suicide. Initial research highlights that TGQ college students have higher rates of psychological distress, trauma, and suicidal behaviors compared to cisgender peers, though it is unclear how they utilize therapy. To expand upon these findings, 3,166 TGQ and cisgender college student responses from the 2018--2019 Center for Collegiate Mental Health database were used. TGQ students continued to have the highest rates of depression, generalized anxiety, social anxiety, academic concerns, hostility, and eating concerns. Genderqueer students had the highest likelihood of suicidal ideation, non-suicidal self-injury, and recent sexual assault. Transgender students attended the most individual therapy sessions. The results replicate prior work while highlighting the importance of increased training for practitioners and universities to meet TGQ students' needs given their utilization of mental health treatment.