Fifteen-year-old Nathan, born Natalie, has already had an ugly experience with violence.
"[In] fifth grade, he was assaulted at school," said Nathan's mother, Tammy. "A group of boys weren't sure if he was a boy or a girl. And they decided that they -- if they kicked him [in the genitals], that they would be able to find out."
"After elementary school, in junior high, people started thinking of me as the 'weird' kid and the 'different' one," Nathan said.
He was different -- especially from the other girls. "They would want to play with Barbies and do other girlie things. And from a young age, I was really adamant that I was a boy," he said.
Things got so rough at school that his parents decided he should take classes online. That left him even more isolated. He has no friends his age, he said.
"It's hard. I want to be able to hang out with people, you know, go do regular teenage things. … It just feels like I don't have anyone to talk to," he said.
Nathan does his best to be as masculine as possible. But he's already gone through female puberty, and his breasts are a painful reminder of his predicament. He binds them with three layers of spandex.
"I want my boobs gone. I don't want them. I never wanted them in the first place," he said.
He takes drugs that have suspended his period, in effect inducing an early menopause.
"Going through your period is something that's hard for a girl, but for a guy it's just completely embarrassing and wrong and it feels like it shouldn't happen," he said.
Nathan has pinned his hopes on testosterone. He believes shots of the male hormone will give him a boy body to match the way he feels on the inside. His doctor said the hormone will eventually shut down his ovaries, reducing the amount of estrogen in his body. He will grow body hair, his voice will be lower, his breasts will shrink and his muscles will grow. Female puberty will essentially be reversed.
Nathan will be part of the first generation of transgender kids to receive hormones to change their bodies to the other gender. This therapy is controversial for someone his age, as some of the effects are irreversible.
Like Jackie's parents, Nathan's parents have switched pronouns. Nathan took it one step farther, going to court to change his name. He called it "one of the greatest days of my life."
When Nathan and his parents returned home, a backyard family celebration was underway. There was laughter, friends and a cake with "It's a Boy" written in sugar frosting.
Tammy said she wondered how to share the news with family and friends. She went with a new kind of birth announcement.
"I just say, Help us in accepting and loving and welcoming our son. … As of this date, 'he' will no longer be a 'she.'"
Tasha, Nathan's sister, now officially has a brother.
"I support what he wants to be, what he wants to go through. I want him to know that I was there for you. I'm not gonna stop loving you for you wanting to be you," she said with tears.
There are many who believe making social and medical changes at this age is simply too young.
"I've never had a regret. … I don't ever think there will be a regret," Nathan said. "I want to be a boy, and I can't be a girl."
In three to six months' time, Nathan should start seeing the effect of testosterone. To maintain it, he'll have to take the hormone for the rest of his life.
Despite the financial toll, his parents have said in a year they'll pay for a mastectomy to remove his breasts.
He also says he wants his female reproductive tract removed once he becomes an adult.
"I would get it out today if I could," he said.
In the end, he doesn't feel he needs a penis to be male. Neither does Tammy. "I think it's in your head. … I don't think it takes genitals to be a gender," she said.
To fight Nathan's isolation, his parents have taken him from Arizona to Washington State to attend Gender Odyssey, a conference for transgender families like them.
"I've already made some friends," Nathan said soon after arriving.
Nathan says he wouldn't change his journey, painful as it's been.
"I was stuck on the fact that, you know, I would never be biologically male. And then I found out, You know what? I'm me. Whether I'm trans or not, I'm still me."