This paper considers questions of gender integration in transsexuality. While, historically, the medical/clinical establishment has treated the transsexual's desire for surgery as a hysterical demand, I develop the view, with the Lacanian theories of Gherovici and Verhaeghe, that transsexual surgery may signify a means to traverse phantasy and claim one's desire. This formulation depends on Lacan's notion of “the Act.” Along with presenting clinical material, the paper asks: is it useful to think about hysteria while trying to think about gender, identity formation, and sexual difference? Can the demand for surgery be other than a demand for certitude?