Transgender and gender diverse (TGD) youth experience disproportionate rates of stigma and discrimination, contributing to health concerns. TGD people also report limited access to affirming healthcare, yet little is known about TGD youth and affirming healthcare in the Midwestern U.S. We utilized a community-based, mixed methods survey to explore the health and healthcare experiences of TGD youth in Kansas. Participants (n = 89) were predominantly non-binary (49.4%) and transgender boys/transmasculine (28.1%). Approximately 20% reported discrimination by a healthcare provider and half reported at least one affirming experience (58.5%). Affirming practices included providers using correct names and pronouns (43.1%), asking about gender (38.4%), facilitating access to gender-affirmative healthcare services (20.0%), and connecting to TGD resources (18.5%). Thematic analysis of open-ended responses revealed contextual details about TGD youth's experiences. These findings are relevant to medical and mental health providers, as well as advocates training providers to offer more accessible and affirming care for TGD youth. Copyright The Author(s) 2023.