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Despite treaty agreements and Native focused health efforts, health disparities among American Indians and Native Hawaiians (AIINH) have persisted for decades as federal, state, and tribal efforts to address them have waxed and waned. These disparities are even more pronounced among lesbian, gay, bisexual, and transgender (LGBT) individuals . The National Institutes of Health (NIH) has established that LGBT people experience, over a lifetime, an array of health issues such as victimiza­ tion, violence, anxiety disorders, substance abuse, HIV, stigma, and dis­ crimination and have recommended that an agenda be enacted that will "assist NIH in enhancing its research efforts in the area of LGBT health . . . and advance understanding of LGBT health" (National Institute of Medicine [NIM] , 20 1 1 , p. 6). The need to understand the variation found among LGBT people is vital and many have made a call to address this lack of information and to help close the health disparity gap (Lombardi, 20 10 ; NIM, 20 1 1 ) . In an effort to add to the literature and, more impor­ tantly, to provide information on how to better serve and improve the health of American Indian and Native Hawaiian transgender people, this study identified key health research needs . The term trans gender is complex and has a number of meanings but generally it describes "people who have gender identities , expressions, or behaviors not traditionally associated with their birth sex" (Mayer et aI, 2008, p. 990) and may include cross-dressers, transvestites, transgender­ ists, drag queenslkings and other gender variant identities. Among All NH people there are regionally specific terms for trans gender that may include cultural terms such as mahu, mahuwahine, mahukane, winkte, heyoka, midleehi, ditbah, and the contemporary term two-spirit (Roscoe, 1 998) . It is important to note that the trans gender term is evolving and varies by region and individual .

Closing the Gap: A Research Agenda for the Study of Health Needs among American Indian/Native Hawaiian Transgender Individuals