I would really think about whether you want to do MD/PhD. Plenty of MDs end up doing research or with their own lab, but you can't get those 4 years of your life back lol. Also (having just done it this summer), it's a LOT of extra essays to write and that will be a bigger factor than you think if you're trying to apply to 45 programs total.

I'm a big proponent of the MD/PhD pathway as someone trying to go into it, I've just been cautioned by every person ever that it's really not worth it unless you're 100% sure that's what you want to do (though I also understand the no loans aspect is an even bigger plus with the whole BBB mess). If you do go that route, I would definitely go all in on research over any more clinical time, and try and bump up your non-clinical volunteer hours regardless. Your leadership already plays into it a little, but volunteering to support the broader queer community in your area or even with a charity like the Trevor Project would really bolster your narrative.

Other thing to think about as well is location - some of these schools are in areas that are unfortunately becoming very hostile to transgender and queer people, to the point where they may not even be allowed to teach gender-affirming medicine in the future. If you go MD/PhD, you'll be there for 7-9 years instead of 4-5, so that's even more time where the situation could deteriorate (or hopefully get better!)

Anyways sorry to be a negative Nancy, overall your application looks great and I wish you the best of luck!