Epigenetic Differences in Stress-Related Genes in Transgender Minorities Chronic low back pain (CLBP) is associated with substantial costs in the US and living with CLBP can have a negative impact on quality of life. Individuals who identify as racial minorities are often undertreated for chronic pain conditions and report more severe and disabling CLBP. However, whereas there are established sex differences in the expression and treatment of chronic pain, little work has investigated the burden of chronic pain in gender minorities including transgender (trans) men and women. Here we are proposing to recruit transmen (N=15) and transwomen (N=15) to a current study investigating the racial differences in DNA methylation (DNAm) and gene expression in Black and White CLBP sufferers, with an emphasis on stressful environmental exposures. Trans individuals, often racial minorities in the local area, face compounded daily stress, stigma and discrimination related to race, gender and chronic pain. Thus, the addition of this population to the current study will allow a novel investigation of gender identity and the impact on DNAm and gene expression. In line with the Notice of Special Interest (NOD-OD-22-032), we will be adding gender minority participants (i.e. transgender) to an ongoing study (R01AR079178) to allow for the first exploration of gender identity effects on stress-related DNAm and gene expression.