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This chapter examines how conflicting models of trans- therapeutics are worked out in clinical practice. Through analyzing one initial patient consultation in Ousterhout’s office and another in the office of the plastic surgeon Joel Beck, the chapter argues that divergent clinical strategies indicate shifts not only in trans- treatment paradigms but also in broader trends in the ways Americans use surgery. No longer limited by the “wrong body” model of pathology that structured trans- medicine between the 1960s and 1980s, by the first decades of the twenty-first century trans- people could join the ranks of millions of Americans who sought surgery in order to manifest their true selves. This change in treatment philosophy multiplies what it means for trans- surgical interventions to work, thereby implicating a shift in the aims and logics of trans- medicine.

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