This is a long term follow-up of 55 boys with early effeminate behavior. It was possible to determine the outcome in sexual orientation in 38 of the boys, which included homosexuality or variants of it in 35 (63.6 per cent) of the total of 55 and heterosexuality in three (5.5 per cent). In 10 boys the outcome was uncertain, and seven were lost to follow-up. An analysis of the uncertain cases suggests that the overall outcome in terms of homosexuality may prove to have been higher than 63.6 per cent. These results agree with those of previous prospective and retrospective studies, which are reviewed. From both types of such studies, the prospective ones starting out with instances of early effeminate behavior and the retrospective with cases of established homosexuality, the conclusion is ventured that all male homosexuality begins with early effeminate behavior. This has implications for future research on homosexuality.