This story was originally broadcast Nov. 19, 2004
Thirty-five years ago, near Anchorage, Alaska, Juanita and Liana Barbachano were born identical twins. Today, the twin sisters are now sister and brother.
Liana Hoemke is married and a devout Mormon, home-schooling her eight children in rural Texas. Juanita Barbachano is now Juan Barbachano and living near their childhood home in Palmer, Alaska.
How could identical twin girls, conceived from the same fertilized cell, sharing the same DNA, turn out to be so different? This sort of case is as rare as one in 12 million, according to some experts. The compelling and often painful journey of Juanita to Juan raises profound questions about what determines human identity: nature or nurture?
Juan says he felt different from his sister at a very young age. "I knew for a fact by the time I was 3, that I was different, that I wanted to be a boy. That I really was a boy," he told 20/20's Elizabeth Vargas.
Juanita and Liana were the eldest of the Barbachanos' six children. They were raised as Mormons, adhering to the church's rigid traditional values. Like most twins, they were close, sharing their own special language, until Juanita began exhibiting boy-like behavior.
"She was the dominant twin," Liana said. "She was just always masculine, and when we played house, it was always the masculine role that she would play."
"I knew I was going to grow up to be a cowboy," Juan said. "My secret wish was to have Santa Claus deliver the right parts."
When Santa failed, Juanita began wishing that UFOs would steal her away and make her a guy. Convinced that she was a boy trapped in a girl's body, she cut off her hair and started wearing pants.
Juan says he felt humiliated when his parents made him wear dresses, "because boys don't wear dresses."
Juanita's emotional turmoil only heightened when puberty hit. Liana began menstruating nearly a year before she did, and when Juanita had her first period, "my world just went down the tubes."
Juanita had her hair cut short and began to wear loose clothing so people wouldn't notice her breasts. But people did notice. Throughout their childhood, Liana was always there to help her twin endure the cruel teasing from kids at school -- especially during puberty and adolescence.
"They just thought at that time I was a lesbian," Juan recalled. "I hadn't dated anyone. I didn't go to any of my proms. Being biologically female, I couldn't take out the women that I was attracted to. Growing up as religiously as we did, you know, I was constantly made to feel that I was odd, I was perverted."
Life at home wasn't any better. Their parents divorced when the twins were 8. The twins lived with their mother. They say she was physically abusive, and her favorite target was her sexually ambiguous daughter.
The abuse, teasing and sexual confusion came to a head when, at 14, Juanita tried to kill herself. It was the first of several suicide attempts.
"I just could not see the point in living. I mean, there was just too much pain," Juan said.
Admitted to a mental hospital, Juanita was diagnosed with gender dysphoria, confusion about one's sex. When she was released -- her sexual identity still an untreated puzzle -- she found sanctuary in the most unlikely place. Juanita Barbachano became the first girl at her high school to play football.