Psychoanalytic theories of gender identity have come a long way since Freud. The author reviews two dialectics that have shaped psychoanalytic gender theory thus far: first, the tension between theories that emphasize biological versus sociocultural influences on gender, and second, the dialectic between nomothetic (i.e., universalizing) and idiographic (i.e., focusing on individual variation) approaches. The author argues that psychoanalytic gender theory could be further enriched with more attention to two additional dialectics. One involves the so-called gender binary and the relative focus on cultural versus developmental aspects of the binary; a second involves the relationship between gender identity and desire. Attention to these dialectics can help better integrate theoretical and clinical perspectives on gender identity.