It is known that transgender people experience health inequalities. Disparities in hospital outcomes impacting transgender individuals have been inadequately explored. We conducted this retrospective cohort study using the National Inpatient Sample (01/2018–12/2019) to compare in‐hospital mortality and utilization variables between cisgender and transgender individuals using regression analyses. Approximately two‐thirds of hospitalizations for transgender patients (n = 10,245) were for psychiatric diagnoses. Compared to cisgender patients, there were no significant differences in adjusted means differences (aMD) in length of stay (LOS) (aMD = −0.29; p = .16) or total charges (aMD = −$486; p = .56). An additional 4870 transgender patients were admitted for medical diagnoses. Transgender and cisgender individuals had similar adjusted odds ratios (aOR) for in‐hospital mortality (aOR = 0.96; p = .88) and total hospital charges (aMD = −$3118; p = .21). However, transgender individuals had longer LOS (aMD = +0.46 days; confidence interval [CI]: 0.15–0.90; p = .04). When comparing mortality and resource utilization between cisgender and transgender individuals, differences were negligible.