This research explores the online transmedicalist community, a subcommunity within the transgender community whose members view being transgender as a medical condition. The aim of this study is to understand how transmedicalists differentiate themselves from another trans subcommunity called tucutes (whose members instead view being transgender as a social issue). Using content analysis, the study addresses the following questions: What is a transmedicalist ideology, and how is it enacted in transgender identity discourse online? How do transmedicalists differentiate between themselves and tucutes? Why do transmedicalists police the embodiment of tucutes? Results show that transmedicalists create an axis of differentiation through which they posit themselves as scientific and rational individuals, and tucutes as irrational and illogical individuals. Using this axis, transmedicalists form sign relations that they attribute to tucutes. This results in transmedicalists creating boundaries around who counts as transgender out of fear of tucutes harming the trans community.