Testo Junkie’s (Preciado, 2013) far-reaching exploration of desire elides the abject, the (culturally inculcated) underbelly of sex. When speaking of desire clinical psychoanalysis and the academy use similar language regarding fragmentation and the shattering of self. But for clinicians a distinction must be made between jouissance and psychosis. The former requires a transcendence of shame; the latter is imbued with the abject. This essay argues that the burden of unmediated shame is left to the reader of Testo Junkie. A clinical vignette illustrates the juncture of desire, shame, and fragmentation and the necessity of the analyst’s understanding of the difference between jouissance and madness.