signed gender. 
Risk and Prognostic Factors
Temperamental. For individuals with gender dyspho ria without a disorder of sex de-
velopment, atypical gender behavior among individuals with early-onset gender dyspho-
ria develops in early preschool age, and it is possible that a high degree of atypicality
makes the development of gender dysphoria and its persistence into adolescence and
adulthood more likely.
Environmental. Among individuals with gender dysphoria without a disorder of sex de-
velopment, males with gender dysphoria (in both childhood and adolescence) more com-