This paper argues that a conceptual conflation between biology and ontology has had a pervasive influence on psychoanalytic thinking about gender, particularly transgender phenomena. This has made it difficult to think about gender's relationship to the body outside of essentializing fantasies. The origins of the modern term gender and Freud's biological emphasis are addressed, followed by a more extensive engagement with contemporary psychoanalytic scholarship on trans. Finally, the paper proposes a framework for attending to gender's relationship to the body with greater nuance, turning to Freud's late drive theory to help us think in this complex area.