— -- 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.
"I actually felt more free then, because I could be as violent as I wanted to be and not get in trouble for it," Juan said.
But at home, behind closed doors away from the football field, Juanita's internal pain became so unbearable that she began hurting herself again. This time it was self-mutilating -- cutting her breasts.
"I started cutting when I was 17. Up until I was about 25, I did it just about every week. At least once a week," he said. "I advanced to razor blades and the blood and the pain was distracting enough so I didn't have to deal with the feelings that I was going through."
The family's reaction to Juanita's masculine appearance and emotional distress, Liana said, was "embarrassment ... to the point of shame."
She said the family didn't know how to help.
Three years ago, Juanita took the first dramatic step to physically undergo a sex change.
"The argument I made was, 'I've tried it this way for 32 years. It's time to try something else, because I've just been miserable my whole life,' " he said.
In March of 2001, he began testosterone treatment, which he will have to take for the rest of his life. It changed his muscle mass, voice and hair production.
"When I started taking testosterone, I noticed first off, facial hair. Then my voice started dropping, the hair around my temples started receding almost immediately."
Juanita officially became Juan after undergoing a hysterectomy and ovary removal. He changed his name on his birth certificate, driver's license and Social Security number. And last spring, Juan took another bold step, undergoing chest reconstruction surgery.
Today, other than his scars, it is impossible to tell the man was once a woman.
Liana says she's getting used to all the changes in her twin. "The more face-to-face we are, the easier it has become to call him Juan," she said.
Liana said Juan has been straightforward with his nieces and nephews about the sex change. Liana said when her children asked why their aunt wanted to become a man, Juan explained, "My brain is a man's brain, and my body isn't, and I can't change my brain, but I can change my body."
Dr. Nancy Segal, director of the Twin Studies Center at California State University at Fullerton, says she thinks some prenatal factor affected Juan's sexual identity.
What could've happened in that womb to change him so much from his identical twin sister?
"Well, we know that his mother was stressed at certain points in her pregnancy. And pregnant mothers who are stressed will release certain levels of hormones," Segal said.
Just before the twins' birth, their mother was involved in a near-fatal car accident. Segal believes that event may have triggered adrenaline-releasing hormones that affected Juan but not Liana. But it is only a theory.
Juan's body is still in transition. He is saving up for what he hopes will be his last procedure, a phallectomy, the creation of an artificial penis. Now, for the first time, Juan has the confidence to begin a social life that never existed. He even has a female companion, although he says they are not intimate.
Juan says he still struggles with depression, and is on medication for it, but says his life has improved dramatically. "I feel good for the first time in my life, and I like it," Juan said.
For Liana, that is is wonderful to hear. "Now there's a future, and the world would be a lot worse place if he wasn't in it."