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45K miles for a transmission flush? Sounds kind of way too soon to even think about something like that. I don't know what the owners manual for that specific truck exactly says though. Then to pay a dealership to do that for you (or have them do ANYTHING for that matter, outside of completely covered warranty work or recalls) is just allowing yourself to be gouged. Anything a dealership might recommend to you is likely nothing short of a sales tactic. Most are notorious for telling you that you need to have things done (especially for any kind of state inspection or the like) when you most likely do not. Most have become scammers when it comes to maintenance and repairs of cars. We followed dealership estimates for many many years and they always came in on TWICE as much as any other independent garage that knows what they're doing. We've caught dealerships in lies in the past when getting second opinions elsewhere, which has completely eroded our trust in any dealership anywhere anymore.