Abstract Background Asian American and Pacific Islander (AAPI) sexual and gender minority (SGM) young and emerging adults are an especially high-risk group to consider in mental health research, holding multiple marginalized identities & report discrimination based on race/ethnicity & immigration status at double the rate of overall SGM youth. There is a need for extensive national studies that capture the experience of AAPI SGM youth to comprehensively elucidate the mental health burden on this often-overlooked population in the COVID-19 era. This study aims to describe the national landscape of AAPI SGM university student mental health & treatment usage. Methods We data from the Healthy Minds Study, conducted between September 2021-May 2022 (n = 89,255) across 133 campuses in the United States. We used bivariate analyses & cross-sectional logistic regression models to evaluate mental health symptoms, risk/protective factors, & treatment utilization across AAPI SGM students. Results Preliminary findings indicate that 78% of AAPI SGM respondents report the presence of one or more positive screens for depression, anxiety, eating disorder, suicidal ideation, or non-suicidal self-injury. Among these students, approximately 57% report utilizing therapy or psychotropic medication. Experiences of discrimination & financial stress were the strongest correlates of mental health symptoms. Self-reported experiences of discrimination based on race, culture, & sexual orientation were associated with higher odds of treatment utilization for AAPI SGM domestic students but not for international students. Conclusions The data underscore the need to consider the adequacy of current approaches in supporting AAPI SGM mental health, as well as unique ways to foster protective institutional & intrapersonal factors & increase investments to culturally responsive, gender-affirming treatment & prevention programs that address mental health disparities already looming in minoritized communities.