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Using a mixed-methods strategy, I examine the social life of “evidence” in how providers of transgender medicine make decisions in assessing their patients’ requests for gender transition-related interventions. Beginning in the 1950s, medical providers created evidence to justify normalizing trans people. Over time, they have increasingly relied upon the rhetoric of scientific evidence to normalize the profession and practice of trans medicine. In analyzing how “evidence” changes over time, for what purposes, and to what effect, the history of this medical arena refracts attention on broader concerns in contemporary social life regarding the unintended consequences of evidence manipulation across institutional domains.