In 2007, a Brazilian federal appeals court ruled that gender affirming care was guaranteed on the basis of the constitutional right to health. This is part of a broader process of the “judicialization” of the right to health in Brazil. In this essay, the author draws on fourteen months of ethnographic fieldwork conducted at a public gender clinic in southern Brazil to consider the experiences of transgender people who accessed surgery through the expanded public services that followed the litigation. The article argues that access to surgery does not, by itself, ameliorate the intersecting forms of vulnerability and exclusion experienced by the people followed by the author. Yet despite the limitations of a focus on surgery, expanded access to care does create possibilities for trans people to engage in diverse forms of self-transformation. The paradigm of access to gender affirming care through right-to-health litigation circumscribes the possibilities for social transformation within a set of biomedical technologies that come to stand for more radical change. Attending to the diverse forms of care and self-governance that trans people themselves labor to enact offers a more productive register for thinking about the socially transformative potential of the judicialization of health in Brazil.