June 27, 2008 -- Last year Barbara Walters spoke with the families of three transgender children who agreed to share their story. Now, one year later, "20/20" has reached out to the families again to learn what's happened since the original "20/20" episode aired. All three families said that the story helped change their world for the better. Advocacy groups also report a significant surge in young transgenders coming out. Read below to find out more about Riley.
During Christmas of 2006, Riley Grant received a present that can be described as bittersweet -- a video game that allowed her to morph a digital body into anything she wanted. Almost immediately, Riley, then a 10-year-old transgender girl who is biologically a boy, adopted a virtual female persona. If only life were so easy, that she could punch a button and turn into a girl.
"She has a birth defect, and we call it that. I can't think of a worse birth defect, as a woman to have, than to have a penis," Riley's mother, Stephanie, told Barbara Walters. "She talks about the day she'll have a baby. That's not in her future. But she sees herself as growing up to be a woman."
Twelve years ago, the struggle the couple faced was simply to have a child. It took Stephanie and her husband, Neil, eleven attempts at invitro fertilization and five miscarriages before Stephanie finally gave birth to fraternal twins -- a girl, Allie, and a boy, Richard. ("Grant" is an alias being used to protect the family's privacy).
From the beginning, the Grants knew that the twins were different. While Allie was outgoing and friendly, Richard was clingy, quiet and passive. His mother knew that he wouldn't become a macho little boy.
'I'm A Girl'
Richard refused to swim topless, always wearing a shirt in the pool. By age two, he became clearly jealous of his sister's "girl" things -- her toys, her pink drinking cups, and especially her clothing.
"We were getting dressed, and he wanted to wear a dress. He wanted to be pretty like his sister," said Stephanie. "He was saying, 'I want a dress. I'm a girl, Mommy, I'm a girl.' And I'd say, 'No, honey, you're a boy. You have a penis, you're a boy. Allie's a girl.'"
Then, when the twins were only two and a half, an incident after a bath convinced the Grants just how seriously confused their son was about his gender identity. Stephanie found Richard holding a nail clipper against his penis, saying that "it doesn't go there."
Richard's pediatrician told the Grants that they needed to teach their son how to be a boy. So the Grants encouraged Richard to play with boy's toys and do boy's activities, but to no avail. Richard even refused to attend his own birthday parties knowing he would only get boy presents. The worst time was Christmas.
"It got more exasperating for him when he looked over and saw his sister's things, the things that he wanted," said Neil Grant.
'We Knew We Had to Hide It'
Finally, when Richard was just three years old, Stephanie made the drastic decision to let her son start dressing as a girl. They called it "girl time." Richard could dress up in his sister's clothes but only when his father Neil was out of sight. The secret between mother and son went on for months.
"I took him shopping by himself and we bought his own skirt and his own little tank top because that little girl trapped inside was so happy when this would happen. But we knew we had to hide it, and we hid them in the back of the closet," she said.
When Neil finally found out that his wife was allowing their son to dress as a girl, he became upset. "I said, 'I didn't believe in it, and I didn't know where this was going to lead to.'"
Richard's double life put a strain on the Grant's marriage, and they almost separated. Richard, now four, was going to school as a boy but wanted to be a girl full time. Stephanie knew about Richard's heart-wrenching prayers in the middle of the night.
"He said, 'Mom, I'm so mad at God, because God made a mistake. He made me a boy, and I'm not a boy, I'm a girl, Mom. Every night I pray that God gives me a girl body but when I wake up I'm still a boy. God won't take back his mistake, he won't make it right,'" Stephanie recalled.
Gender Identity Disorder
At one point, Richard became so despondent that his parent's feared he may try and harm himself. Richard began talking about jumping out of windows, prompting the Grants to constantly lock their windows shut.
Richard also began to have regular breakdowns. After one particularly severe panic attack, in March 2003, Richard's face turned blue and he had to be hospitalized. Feeling helpless, Stephanie spilled all of her secrets to Richard's principal.
The response took Stephanie by surprise: Why couldn't Richard come to school in a dress, the principal asked. Then the school directed the Grants to a gender specialist who diagnosed Richard with Gender Identity Disorder.
For Stephanie, the diagnosis came as a relief. "Oh my God, we're not making this up. This is real. There's a diagnosis," she said.
So Richard, only seven years old, began to transition from a boy to a girl. He -- now she -- pierced her ears, grew her hair out, wore girls' clothing and took the name "Reggie." Her father, Neil, who once rejected her, took her shopping for dresses. He finally understood after seeing the look on his daughter's face.
Reggie eventually changed her name legally to Riley. But when she showed up at school in the third grade wearing a dress, her life became increasingly difficult. She was only allowed to use the bathroom in the nurse's office, and the bullies had a field day.
"It became a nightmare. It was horrible. She was known as the girl with a dick," said Stephanie. Riley came to believe that the only kids who liked her were the ones who didn't know that she used to be a boy.
Riley told Barbara Walters that the constant teasing makes her angry. "Some people call me a boy. But I just tell them to shut up," Riley said.
Riley also has a tough time being around her twin sister Allie, and the two fight often.
Stephanie explained, "Her sister has always been right. Her twin was born with the right body. Her twin is going to get the breasts. She has to hate her sister in order to survive." Neil added, "Her twin sister is everything she wants to be."
But the most difficult time for Riley, Stephanie says, is when she's alone with her body. Stephanie recalled how once, when Riley was still Richard, she peeked into the shower and saw him washing his hair with one hand while keeping a washcloth over his genitals with another.
Stephanie said, "He was hiding from himself. He didn't want to see his own body."
Now on the cusp of adolescence, Riley's anxieties over her body will only surely grow. According to Dr. Norman Spack, an endocrinologist at Harvard University, puberty is especially frightening for transgender children.
"They feel like their body has gone completely out of control, and I've heard genetic males, who assume a female identity, say please, please, please don't let me grow a beard, like daddy, or a voice like my big brother," Spack said. "They know which physical attributes are going to be absolutely threatening to their entire future ability to blend in."
Of female to male transgenders, Spack said, "The thought of developing breasts is bad enough, but the thought of developing monthly periods is enough to make some of them cut themselves every time they have one."
Doctors are divided over the best way to treat transgender children. Some believe that puberty, despite the extreme distress that accompanies it, is crucial for a child's development and should be allowed to take its natural course.
But a growing number of specialists, including Dr. Spack, believe that early intervention is a better option, and the Grants say that Riley can't wait to undergo this protocol. First, at the onset of puberty, hormone blockers are prescribed to stop the surge of hormones coursing through an adolescent's body.
"It basically puts you at a kind of pre-pubertal state, or in limbo, so to speak. Still growing, but not really maturing in either direction," said Spack, founder of the Gender Management Service Clinic at Children's Hospital of Boston.
A few years later, cross-hormones are taken. For biological males, this means taking estrogen; for biological females, testosterone. These cross-hormones simulate the puberty of the opposite sex. In Riley's case, for example, estrogen will cause her to grow breasts and develop a feminine body shape.
But hormone therapy is expensive and comes with risks. Riley increases her chances of getting breast cancer because of the estrogen. And cross hormones render transgender teenagers sterile.
Then there is the question of if and when to have sex reassignment surgery. "Riley would have it done tomorrow," Stephanie said.
For the Grants, the future is full of questions, while the past seems like a fleeting memory. It's rare that Stephanie allows herself to look at pictures of Riley as a boy. Normally, they are all hidden. She only looks at them when her trans-daughter is not around. If Riley found them, she would destroy them.
Still, the Grants hope that by going public with their private pain, they will help others to comprehend what Riley and other children like her have been through. "I want Riley to have a good life, and for more people to understand the way she is," said Neil Grant.
Stephanie added, "We have to support her, but we don't walk in her shoes. And people who look at her and know her will, I hope, realize what it takes for her to be her every single day."
ABC News' Joneil Adriano and Jennifer Joseph contributed to this report.
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