Transgender people have long been associated with sexual perversion. For example, many early versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) infamously categorized any gender variance as sexual deviance or paraphilia. This article therefore investigates the taxonomical movement away from the transgender subject as perverse toward the current diagnosis of gender dysphoria, which instead consolidates the transgender subject as distressed and suffering. Through an unconventional use of psychoanalytic theories of perversion, I argue that DSM-5’s new diagnosis criteria work defensively, functioning as an antidote to the clinician's anxiety in the face of difference. When separated from stereotypical acts and identities, perversion proves to be quite valuable in understanding clinical transphobia. In particular, Freud's writings on fetishism and disavowal reveal some of the unconscious roles at play in the repeated medicalization of trans people and the restricting of transition-related resources. Through the donning of a fetish object, disavowal acts to ignore an upsetting reality while the traumatic truth remains intact. An analysis of Chase Joynt's video installation, Resisterectomy, provides grounded narratives of gendered surgery and illness that disrupt anticipated affects, temporalities, and curative measures.