The National Institute on Minority Health and Health Disparities has noted that transgender individuals experience unique health disparities. We sought to describe the landscape of transgender patients with cirrhosis. We identified all trans- and cis-gender adults in Optum's de-identified Clinformatics® Data Mart Database between 2007-2022 using validated billing codes, calculating age-standardized prevalence of cirrhosis among cis- vs. transgender adults. Among those with incident cirrhosis diagnoses, we calculated age-standardized incidence densities of liver-related outcomes (decompensation, transplantation, hepatocellular carcinoma), and all-cause mortality. We examined 5-year survival using inverse probability treatment weighting (IPTW) to balance trans- and cis-gender populations on demographic and clinical characteristics. Among 64,615,316 adults, 42,471 (0.07%) were transgender. Among 329,251 adults with cirrhosis, 293 (0.09%) were transgender. Trans- (vs cis-)genders had higher prevalence of cirrhosis (1,285[95%CI 1,136-1,449] per 100,000 vs 561[559-563] per 100,000). Among adults with cirrhosis, trans- (vs cis-)genders had higher proportions of anxiety (70.7%[56.9-86.9] vs 43.2%[42.7-43.8]), depression (66.4%[53.3-81.7] vs 38.4%[37.9-38.9]), HIV/AIDS (8.5%[3.9-16.1] vs 1.6%[1.5-1.7]), and alcohol (57.5%[46.0-71.1] vs 51.0%[50.5-51.6]) and viral (30.5%[22.8-39.8] vs 24.2%[23.9-24.5]) etiologies, although etiologies had overlapping confidence intervals. Trans- (vs cis-)genders had similar incidence densities of death (12.0[95%CI 8.8-15.3] vs 14.0[13.9-14.2] per 100 person-years), decompensation (15.7[10.9-20.5] vs 14.1[14.0-14.3]), and liver transplantation (0.3[0.0-0.8] vs 0.3[0.3-0.4]). In IPTW survival analysis, trans- and cis-gender individuals had similar 5-year survival probabilities (63.4%[56.6-71.1] vs 59.1%[58.7-59.4]). Trans- (vs cis-)gender adults have double the prevalence of cirrhosis and the majority have a diagnosis of anxiety and/or depression. These results are informative for researchers, policymakers, and clinicians to advance equitable care for transgender individuals.