ABSTRACT Queer theory pushes us to resist normativity, question power structures, and strive for liberation. Queer-affirming practice encourages trauma-informed, consensual, accountable, and reciprocal care. Theoretically, the values of queer theory, queer-affirming practice, and social work are adjacent, if not intrinsically interconnected. However, social work education often relies on practices rooted in oppressive frameworks wedded to traditionally western and colonist socio-behavioral science standards that go unchallenged. For example, encouraging the appropriation of clients’ lived experiences for students’ learning and instructors’ teaching needs reinforces this complex, as this practice can be exploitative and reductive. Similarly, training social workers to engage clinical exercises without the transparent consent of their clients dehumanizes clients and reinforces imbalances of power. Inspired by Alex Iantaffi’s approach of irreverence in Gender Trauma and queer theory’s analysis of power, the practice of case studies (i.e. formulations, analyses, etc.) is questioned and subverted. Through an example of how the gatekeeping process of gender-affirming surgery letters can be practiced with “queer irreverence,” this piece offers tools for applying such irreverence in clinical practice, informing liberatory paths forward.