This article focuses on issues of gender identity and bodily integrity in the context of profound desires to modify the body. It contends that, while hormonal and surgical interventions in treating gender dysphoria must continue to be considered medically necessary for many people, we do not yet fully understand why it is justified as medically necessary for this condition and not for others with similar features. The article discusses the difference between the medical classification of “gender dysphoria” and “body dysmorphic disorder” and the notion of mental distress in embodiment. It discusses the role that gender essentialism may have played in the medical sanction of hormonal interventions and gender reassignment surgeries. Finally, it proffers the alternative justificatory criterion, following Eve Kosofsky Sedgwick, of “propriodescriptive authority” and explains why this justification, though highly subjective, provides better rational grounds for adjudicating which types of body modification can be considered medically necessary, grounds that can include, but also go well beyond, cases of gender dysphoria.