In Tier II, through Transform Health Arkansas, we have deepened our engagement with transgender/non-binary (trans/NB) Arkansans around the issues they prioritized in Tier I, built capacity and understanding through education, formed new partnerships locally and nationally, assessed existing evidence related to our priority topics, and developed comparative effectiveness research (CER) questions addressing trans/NB priorities. Our research working group, the Transform Health Arkansas Partnership (THAP), comprises trans/NB individuals, providers, and researchers and continues to guide our initiative. In Tier III, we will submit a Letter of Intent to PCORI and prepare a CER proposal focused on increasing availability of trans-competent care. We will compare two system approaches to increasing access to hormone replacement therapy (HRT) for trans/NB people not currently able to access these services locally: telemedicine with gender specialists based centrally or HRT provided by a local primary care physician. Under the umbrella of the THAP we will establish a trans/NB advisory group, a provider advisory group, and a research project team that will meet separately and work collaboratively between quarterly meetings of the THAP. The THAP will be co-led by a trans/academic team as we identify and recruit practices in four southern states willing to participate in our study, synthesize and vet existing educational resources about transgender health to use in training participating practices, examine telemedicine options and feasibility of implementation, develop our study design and metrics for assessing outcomes, deepen external stakeholder engagement, communicate our progress to the trans/NB community, and seek additional funding opportunities addressing our priorities.