| Summary: | Objectives. To investigate the association between gender affirmation and interest in adoption among transgender, nonbinary, and gender-diverse adults. Methods. We analyzed data from the Washington Priority Assessment in Trans Health Project, which was conducted in Washington State in 2023. We controlled for sociodemographic characteristics and health care indicators using multinomial logistic regression. Results. Of the 788 participants, 56% expressed interest in adoption, 24% were undecided or maybe interested, and 20% reported no interest. Participants who expressed interest in adoption were more likely to have updated their legal name documentation (adjusted odds ratio [AOR] = 4.7; 95% confidence interval [CI] = 2.73, 8.08), were more likely to have private insurance (AOR = 11.01; 95% CI = 2.89, 42.02), and were less likely to have food insecurity (AOR = 0.46; 95% CI = 0.20, 0.82). Participants who were undecided about adoption reported higher rates of legal gender affirmation (AOR = 1.59; 95% CI = 1.04, 2.42), educational attainment (AOR = 3.77; 95% CI = 1.19, 11.91), and internalized transphobia (AOR = 1.53; 95% CI = 1.01, 2.34). Conclusions. Legal gender affirmation and health care access were associated with adoption interest and were significantly influenced by economic stability and psychological factors. Comprehensive initiatives are needed to develop more trans-inclusive family-planning services. (Am J Public Health. 2026;116(2):229–239. https://doi.org/10.2105/AJPH.2025.308312)
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