Along with at least six of the following, an associated significant distress or impairment in function, lasting at least six months.

James has no impairment, and has never had an impairment, at his Father’s home. James does not meet the insistent, consistent and persistent tests.

1. A strong desire to be of the other gender or an insistence that one is the other gender.

James does not the meet insistence test for gender dysphoria. He says he wants to be a girl only at Ms. Georgulas’s home. When James is with his Father, he refuses girl’s clothes, says he is a boy to family and to friends, refuses to play with girls, and engages in typically male play.

2. A strong preference for wear- ing clothes typical of the opposite gender.

When at Father’s home, James exhibits a strong preference for boy’s clothing. James exhibits a preference for wearing girl’s clothes only when at Ms. Georgulas’s home. This is forced on James, because he is afraid and because Ms. Georgulas only gives James love if he acts like a girl.

But even if we accept that he prefers it at his Ms. Georgulas’s home, such preferences would not be strong as the diagnosis requires, simply because he lacks any intensity whatsoever to wear girl’s clothes at Father’s home. In fact, James has negative intensity. James refuses to wear anything feminine at Father’s home.

3. A strong preference for cross- gender roles in make-believe play or fantasy play.

When at Father’s home, James ex- hibits a strong preference for male role-play. James exhibits a preference for girl roles only when at Ms. Georgulas’s home. This is forced on James, because he is afraid and because Ms. Georgulas only gives James love if he acts like a girl.

But even if we accept that he prefers it at his Ms. Georgulas’s home, such preferences would not be strong as the diagnosis requires, simply because he lacks any intensity whatsoever to play girl’s roles at Father’s home. In fact, James has negative intensity.

James refuses to play girl’s roles at Father’s home.

4. A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender.

When at Father’s home, James exhibits a strong preference for normal boys toys, games and activities. James’s favorite activity is art, chess, doing magic tricks, rock and boomerang throwing, running and racing, and wresting. James exhibits a preference for girl toys, games or activities only when at Ms. Georgulas’s home. This is forced on James, because he is afraid.

But even if we accept that he prefers it at his Ms. Georgulas’s home, such preferences would not be strong as the diagnosis requires, simply because he lacks any intensity whatsoever to play girl’s toys, games or activities at Father’s home. In fact, James has negative intensity. James refuses to play with girl’s toys, games or activities at Father’s home.

5. A strong preference for playmates of the other gender.

When at Father’s home, James exhibits a strong preference for male playmates. James does not exhibit a preference for girl playmates at Ms. Georgulas’s home. He has friends of both sexes.

But even if we accept that he prefers it at his Ms. Georgulas’s home, such preferences would not be strong as the diagnosis requires, simply because he lacks any intensity whatsoever to play with female playmates at Father’s home. In fact, James has negative intensity. James prefers to play with male playmates at Father’s home.

6. A strong rejection of toys, games and activities typical of one’s assigned gender.

When at Father’s home, James exhibits a strong preference for male toys, games and activities. James exhibits a preference for girl toys, games and activities only when at Ms. Georgulas’s home. This is forced on James, because he is afraid.

But even if we accept that he prefers it at his Ms. Georgulas’s home, such preferences would not be strong as the diagnosis requires, simply because
he lacks any intensity whatsoever to play girl’s toys, games and activities at Father’s home. In fact, James has negative intensity. James refuses to play girl’s toys, games and activities at Father’s home.

By and large, James rejects girl toys, games and activities identity with his father.

7. A strong dislike of one’s sexual anatomy.

James has never expressed a dislike of his sexual anatomy.

8. A strong desire for the physical sex characteristics that match one’s experienced gender.

James has never expressed a desire for female physical sex characteristics.