In presenting the case of Andy, I hope to demonstrate the complicated multidetermined functions of feminine identifications and strivings in a boy with a diagnosable gender identity disorder. My patient's fantasies of wishing and needing to be a girl were not just the result of the influence of parental behavior and attitudes. Equipmental problems resulting from inborn factors and interferences with optimal development due to ongoing interaction with his environment were major contributing influences. Andy's experience of his body and his psychological elaboration of certain childhood events as well as his sexual and aggressive fantasies strongly influenced his feminine desires.