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Highlights * One-third of transgender Ontarians engaged in heavy drinking monthly or more. * This prevalence was 1.5 times that of the age-standardized background population. * Female-to-male spectrum gender identity was robustly associated with heavy drinking. Abstract Background Drawing on a survey of transgender people in Canada’s most populous province, we estimate the frequency of heavy episodic drinking (HED), compare HED prevalence to the age-standardized background population, and examine associations with socio-demographics, gender transition, and social exclusion. Methods 433 transgender persons aged 16+ completed a respondent-driven sampling survey in 2009–2010. Analyses were weighted using RDS II methods, including frequencies and prevalence ratios. Overall and sex-specific estimates of HED among Ontario residents in the 2009–2010 Canadian Community Health Survey (n = 39,980) were standardized to the overall and gender-specific transgender age distributions. Results Estimated prevalence of HED at least monthly among transgender Ontarians was 33.2% (95% CI: 26.3, 40.1), 1.5 times greater than expected based on the age-standardized Ontario population. Transmasculine (female-to-male spectrum) persons were more likely than transfeminine persons to report HED (42.2% versus 22.7%), an effect robust to covariate adjustment. Current sex work was associated with greater HED, but gender transition and social exclusion factors were not. Conclusion Gendered pathways to alcohol misuse, particularly among transmasculine persons, warrant further research and intervention development.