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Transgender and gender diverse adults have higher rates of cervical and other anogenital cancers than their cisgender peers. Vaccination against human papilloma virus (HPV) is known to prevent >90% of cervical and other genital cancers, as well as many oropharyngeal cancers, and thus may be an important tool in childhood and adolescence to prevent cancer in adulthood. The objective of this study was to assess the rates of HPV vaccination in gender diverse youth and reasons for not initiating HPV vaccination. This is a retrospective chart review of all patients at least 11 years old who were seen in a multidisciplinary pediatric gender program from March 2015 to December 2020. Data were abstracted on patient demographics, HPV vaccine initiation, and reasons for not initiating vaccination. Frequency counts and percentages were used to describe the total patient population and subgroups based on sex assigned at birth. Outcomes were compared between subgroups using chi-square tests. This study was approved by our institution's Institutional Review Board. Of the 163 patients ages ≥11, 133 (82%) had initiated HPV vaccination. Demographic characteristics of those who had and had not received the HPV vaccine series are listed in Table 1. Patients who initiated the vaccines were significantly older than those who had not (15.1 vs. 13.7 years, P <.001). Although a higher proportion of patients who were assigned male at birth had started the vaccine series than those assigned female at birth (88% vs. 80%), there was no significant difference between these groups. Reasons given for not receiving the HPV vaccines included parental concerns about both short- and long-term side effects, planning to wait until their child was older, and being opposed to vaccines in general or the HPV vaccine specifically. While the majority of our gender diverse patients had initiated the HPV vaccine series and our rate was actually slightly higher than the national average, it was lower than for other age-concordant vaccines. This was especially pronounced for younger patients, despite the early recommended age of vaccination. As transgender and gender diverse patients have higher adult rates of HPV-related cancers, increased uptake of HPV vaccination during childhood and adolescence could have a significant impact in this population. Further research is needed to determine how to improve vaccination uptake in gender diverse youth, especially at earlier ages. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1378479-1-ANY.docx [ABSTRACT FROM AUTHOR]