People who want gender-affirming surgery without a change in social role represent a range of unique perspectives and use a range of self-descriptive terms, including transgender, transsexual, genderqueer, gender nonconforming, TGNC, nonbinary, and cross-dresser. They may seek surgery to reduce gender dysphoria or to enhance gender euphoria. Professional literature and medical protocols such as the World Professional Association for Transgender Health's (WPATH) Standards of Care, version 7 (SOC-7), have been developed to reflect the needs of people who want to change their social role as well as their body. Medical protocols including SOC-7 recommend a period of “real-life experience” as a criterion for some surgeries, which is not appropriate for people who want medical without social transition, who may want a private expression of gender, and who are at high risk for self-treatment and self-injury. This article describes the many factors that may affect transition and surgical choices. A composite case example is presented to illustrate how surgery without social transition might enhance the life of a female-identified person who lives socially as a man. Medical and mental health providers do provide treatment for people who want medical transition without social transition, but the practice has yet to be well documented.