All of the Following Apply to the Diagnosis of Gender

All of the following apply to the diagnosis of gender dysphoria EXCEPT:

A) A marked incongruence between one's expressed/experienced gender and biological gender at birth (i.e., natal gender or assigned gender) .
B) It must cause significant distress or impairment in functioning.
C) It can be diagnosed when a child has doubts about his or her gender.
D) It is rare.