Gender minorities experience unique minority stressors that increase risk for psychiatric disorders.  Notably, gender minorities are four and six times more likely than their cisgender female and male peers, respectively, to be treated for or diagnosed with obsessive-compulsive disorder (OCD).  Despite higher rates of OCD, more comorbidities, and minority stressors, little is known about the clinical presentation of and treatment effectiveness for gender minorities with OCD.  Using a sample of 974 patients in specialty treatment programs for OCD, the current study found that gender minorities reported more severe contamination symptoms and greater incidence of comorbid substance use/addiction, trauma/stressor-related, personality, and other/miscellaneous disorders compared to cisgender male and female patients.  Despite significantly longer lengths of stay, gender minorities reported less symptom improvement across treatment compared to cisgender male and female patients.  Findings underscore the need for continued research to improve the effectiveness and individualization of treatment for gender minorities with OCD.