digraph G {
"sexual orientation" -> femininity
"erotic target\n location error" -> autogynephilia
"sexual orientation" -> autogynephilia
femininity -> transition
autogynephilia -> transition
"cultural factors" -> transition
}

digraph G {
subgraph { 
  rank = same; femininity; "autogynephilic sexuality"; "cultural factors";
} 
"sexual orientation" -> femininity
"erotic target\n location error" -> "autogynephilic sexuality"
"sexual orientation" -> "autogynephilic sexuality"
"autogynephilic sexuality" -> transition
"autogynephilic sexuality" -> "beautiful pure\n sacred self-identity\n thing"
"beautiful pure\n sacred self-identity\n thing" -> transition
femininity -> transition
"cultural factors" -> transition
}