University counseling centers (UCCs) are an important resource for sexual and gender minority (SM/GM) students as they navigate their college experience. This study investigated the mental health needs of SM/GM collegiate clients in 2020-2021 as compared to the mental health needs of SM/GM collegiate clients in 2012-2015. The analyses also specifically explored the current mental health needs of asexual, pansexual, and gender non-binary collegiate clients. Data were from the Center for Collegiate Mental Health 2012-2015 and 2020-2021 academic years. Results indicate SM/GM identifying collegiate clients in 2020-2021 are younger, more racially diverse, reporting more mental health needs, and utilizing services at UCCs at double or triple the rate as compared to 2012-2015. In 2020-2021, all SM/GM clients had more mental health needs than their non-marginalized peers. Asexual and non-binary clients were demographically similar to their peers, while nearly half of the pansexual clients were racial minority identifying, were more often first-generation, and were younger than their peers. Asexual clients showed acute mental health needs as compared to the other SM groups, whereas pansexual and non-binary students had higher levels of reported symptoms than their respective comparison groups. Implications for UCCs including specialized inclusive services and intentional campus relationships are discussed.