Questions about the removal and preservation of fertility and how far this should be a concern when judging the rights and wrongs of gender confirmation surgeries in particular might seem more ethical than theological per se. Questions about the ethics of removing ‘healthy’ body parts, as in the case of gender confirmation surgery but examined here through the lens of discussions of other elective surgeries that tend to baffle observers, are also often cast more as moral dilemmas than as ways into broader theological anthropologies. However, these concerns are, of course, also deeply theological, as I will show particularly in the latter part of this chapter: they speak into how we understand our vocation as persons and animals and prompt re-examinations of procreation’s centrality in Christian theology, an expansion of the one I attempted in Cornwall (2017).