As student athletes exhibit unique alcohol use patterns based on being in- versus out-of-season and biological sex, we aimed to explore student athlete (N = 442) alcohol use, pregaming behaviors, and associated negative outcomes. Results suggest being out-of-season and male are positively associated with negative alcohol-related consequences, and male athletes report greater numbers of pregame specific alcohol-related consequences than female athletes (p < 0.05). Female athletes indicated significantly higher estimated blood alcohol concentrations than male athletes on pregaming nights. No differences emerged between in- and out-of-season athletes on pregame consequences. Results suggest that further emphasis on the role season status and sex has on pregaming behaviors and experiencing negative outcomes may be an important next step toward enhancing prevention and intervention approaches.