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Through ethnographic research at a surgical workshop focused on trans\u2010 genital reconstruction and in a U.S. hospital working to grow its transgender health program, this article shows that effects of the decades\u2010long insurance exclusion of trans\u2010 surgery are not easily remedied through the recent event of its inclusion because patient access is not the only thing that has been restricted by coverage denial. Decades of excluding coverage for trans\u2010 genital reconstructive surgery have limited the development and circulation of technical skills required to perform these procedures, as well as the administrative processes needed to integrate them into existing clinical workflows. One surgeon estimates that turning expanded access into realized care is \u201ca five or six\u2010year problem.\u201d<\/jats:p>","DOI":"10.1111\/maq.12484","type":"journal-article","created":{"date-parts":[[2018,11,8]],"date-time":"2018-11-08T15:06:34Z","timestamp":1541689594000},"page":"282-301","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["A Capable Surgeon and a Willing Electrologist: Challenges to the Expansion of Transgender Surgical Care in the United States"],"prefix":"10.1111","volume":"33","author":[{"given":"Eric","family":"Plemons","sequence":"first","affiliation":[{"name":"School of Anthropology University of Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,2,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/01459740.2010.501314"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.3432"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2016.10.001"},{"key":"e_1_2_9_5_1","volume-title":"Diffusion of Innovation in Health Care","author":"Cain M.","year":"2002"},{"key":"e_1_2_9_6_1","first-page":"477","volume-title":"Principles and Practices of Sex Therapy","author":"Carroll R. 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