Ten subjects who exhibited feminine behavior and cross-dressing as young boys are described. At follow-up, 8 to 10 years later, 4 are heterosexual, 2 are homosexual, 1 is transsexual, and the outcome is uncertain in 3. Of the eight who met DSM III criteria when evaluated, three are heterosexual, two are homosexual, one is transsexual, and the outcome is uncertain for two. Gender dysphoria appears to be a necessary but not sufficient factor in a transsexual outcome. The strength, rigidity, and persistence of cross-gender behavior through latency may be a good predictor of transsexual outcome.