"Clinical judgment, rather than an indiscriminatory tabulation of risk-enhancing factors for suicide, will ultimately be needed, as “no study has identified one specific risk factor or set of risk factors as specifically predictive of suicide or other suicidal behavior”. Risk-enhancing factors for suicide may act in a synergistic manner, with mood disorders, substance use, physical and sexual abuse, minority sexual orientation, disturbed family relationships, parental psychopathology, and various precipitating stress events leading to near-infinite permutations of suicide risk that is ultimately expressed and unique on an individual level. This is especially the case for TGD individuals, for they constitute “heterogeneous groups of individuals with multiple intersecting identities” that may contribute to different levels of risk for suicide."