Follow This Transgender Teen’s Transition to Match His Identity Before Adulthood ABC News' "Nightline" followed this teen's journey from Natalie to Nathan.

 -- intro: When Nathan* was a fourteen-year-old, he was like a lot of boys his age. He loved rocking out, riding his bike and sports of all kinds. But there’s more to him than meets the eye.

Anatomically, Nathan is female and was originally born a little girl named Natalie.

Transgender Teen Reunites With Second Grade Counselor Who Helped Him Get Through Life

“I always remember just being different from all the other girls. You know, they would want to play with Barbies and do other girlie things, and I always wanted to play with the boys,” Nathan, from Phoenix, Arizona, told “Nightline.” “I always thought I was different than any of the girls, and from a young age, I was really adamant that I was a boy.”

He's so adamant that at 4 years old, the pre-schooler said, “I’m a boy,” and as a second grader, wrote flyers that said, “I am not a girl. I am a boy,” to hand out to classmates.

Back then, his parents missed the signs.

“We really fed into society’s way of saying that, you know, what does a four-year-old know?” Nathan’s mother Tammy told “Nightline.”

“You know, you ask a four-year-old, ‘What do you want to be?’ And they say, ‘Superman,’ … next week, it might be ‘Spiderman,’” Jim, Nathan’s father, told “Nightline.”

They assumed Natalie was just a tomboy who preferred boy’s clothing and toys. But, finally at age of 13, Natalie asked to be called Nathan, coming out to them as transgender.

“I've always felt like I've had a boy's brain,” said Nathan. “And I always felt like I was trapped in this girl's body.”

“If someone were to wake up in the wrong body, they would be the same way,” he explained. “They'd be uncomfortable. They'd be freaking out. And that's what it's like. You just feel uncomfortable.”

Tammy and Jim accepted Nathan as their son and started using male pronouns. And now with their support and help, he is one of growing number of transgender kids who are transitioning both socially and medically, all before adulthood.

“It’s finally giving him what he needs,” said Tammy, who said she regrets not realizing it sooner.

In 2011, they had already consulted with physicians and therapists as they prepared to launch Nathan into the first generation of transgender kids, and they agreed to let “Nightline” document the transformational journey over several years.

In going public with their story, they asked for tolerance and recognition for what the “opposite path” looks like. In the last six months, at least six transgender teens have committed suicide because they felt unsupported by parents or peers, according to news reports. In fact, a staggering 41 percent of transgender youth will attempt suicide before age 25, according to studies on the population.

“Little kids, you know, have a hard time dealing with these feelings,” Dr. Marvin Belzer, who helps run the largest transgender youth clinic in the county at Children’s Hospital Los Angeles, told "Nightline." “Then they get into adolescence, and their body starts going through the wrong puberty. And it just becomes a panic. And they get depressed and suicidal.”

For teens in particular, those feelings are often compounded by social stigma and prejudice. “The percentages [of] how many were spat on and how many were hit, how many had to drop out of school, are horrendous,” he said.

Current estimates are that one out of every thousand children is transgender, according to Belzer.

“So, if you have a school of a thousand kids,” he said, “you probably have one.”

Click through to follow Nathan's journey.

*Nathan is a pseudonym used at the family’s request.

quicklist:1 title:Spring 2011 text:“Nightline” first met Nathan when he was 14 years old in 2011. He and his parents were preparing for his multi-phase transition.

“Five years on testosterone will get a lot of the irreversible changes that he wants, and the voice change, that won't go back, and hair growth and things like that,” said Tammy. “So, then we'll go from there.”

Both she and her husband Jim said they believed the transition was crucial for Nathan’s happiness, because living as girl had made him a depressed and angry child.

His early preference for boyish clothing made him look ambiguous and brought a lot of ridicule. Tammy said in the fifth grade he was assaulted by a group of boys who brutally kicked him in the genitals because they were unsure if he was a boy or a girl. Concerned for his safety, she pulled him out of school and started home schooling instead. He returned to public school for junior high, but Nathan said the cruelty continued.

“People started thinking of me as, ‘the weird kid’ and ‘the different one,’” he said. “I got taunted in the halls. People would, you know, go by and call me, ‘Princess,’ or, ‘girlie,’ or stuff like that, and it was hard.”

At 14, Nathan said it was easier to take classes online, but it left him depressed and even more isolated.

“It's hard. You know, I want to be able to hang out with people, you know, go do regular teenage things. And now, it just feels like I don't have anyone to talk to,” Nathan said.

He tried his best to pass as a boy, but he said his high voice and female breasts were painful reminders of his brain-body mismatch.

“Puberty was a big hard point in my life,” he explained, “I felt like my body was betraying me.”

Every day he wore a thick bra-like tank top to bind his breasts down and frequently hunched over.

“I want my boobs gone, I don’t want them -- I never wanted them in the first place,” he said.

As part of his physical transition, he had just started drugs that suspended his period, similar to an early menopause.

“Going through your period is something that’s hard for a girl,” he said, “but for a guy it’s just completely embarrassing and wrong.” media:30085933

quicklist:2 title:June 2011 text:In the future, Tammy and Jim hope Nathan can re-enter school as a male and be accepted by greater society as the gender in which he identifies. So, after three months of waiting for a hearing date, they went to court to legally change his name.

“Nathan is now officially our son. He doesn’t have to have his female name any longer,” Tammy said.

“I’m going to remember this day as one of the greatest days of my life,” Nathan said, outside the courthouse.

Afterwards, his family held a celebration complete with a cake that said, “It’s a boy,” and Tammy sent out birth announcement cards as a way of letting friends and family know.

“I just say, ‘Help us in accepting and loving and welcoming our son, and then as of this date, she will no longer be she,” Tammy said, displaying the card.

While some critics believe transitioning youth before adulthood is a mistake because they might change their minds, Nathan said he felt male his entire life and did not think he would ever regret any part of his transition.

“This is something I’m going forward with,” he said, “and it’s something that I’ve really wanted.”

According to Dr. Belzer, children under 11 years old do sometimes remit on their transgender feelings, but he said, after 12 years old those feelings are usually set. “The important thing is that you support them and give them a loving environment,” Belzer said, “letting them know, should their feelings persist, there are options to change, if they want to.”

Transgender feelings are not a choice, Belzer said, citing brain and genetic differences that are currently under research. And, considering the difficulties of transitioning, as well as the stigma, he said, “It's clear that these people would not choose to have to go through this life.” media:30085190

quicklist:3 title:May to July 2011 text:Throughout the summer, Nathan saw an endocrinologist in preparation for cross-gender hormone treatment. At home, he created a paper chain to countdown the days to his first shot of testosterone.

“When I get down to one, it’s gonna be one of the happiest days of my life,” he said.

“To have that coursing through his veins, is just what's going to be making him happy,” said Tammy.

In July, he got his first shot. Over time, the testosterone will masculinize his body. His voice will lower, and he will develop more body hair and muscle mass. His breasts will shrink some, and his ovaries and uterus will go dormant. To maintain the effects, he will have to inject the hormone every two weeks for the rest of his life. There are also controversial, irreversible side effects, including potential infertility.

“Nightline” asked Jim and Tammy what they would say to critics who might say "Don’t mess with nature," and ‘What if he changes his mind?" Jim responded, “You can look at it that way, but you can look at it this way, too: would you rather have a happy kid or would you rather have a dead kid?”

Jim said, for him, the answer was clear.

Because hormonal treatment is relatively new for transgender children, some critics caution the long-term impacts are not completely known. “There is some truth to that matter,” said Dr. Belzer. “Except in medicine, we have to weigh the risks of doing nothing…the risks of doing nothing are actually pretty horrendous.”

“If we can help them pass in life, their life is just going to be so much easier,” Belzer explained, “They're not going to have the prejudice and stigma.”

After his first testosterone shot, Nathan went to a Trans support group that his mother helped him find. Though technically an adults group, they welcomed the teenager and helped him celebrate with Testosterone-themed cupcakes. media:30088459

quicklist:4 title:May 2012 text:A year later, Nathan’s parents made the bold decision to allow him, at age 15, to get a double mastectomy to remove his breasts; also known as “top surgery.”

“My parents were [originally] thinking, you can have that when you’re 18. From there it sort of evolved to, okay we need this now,” said Nathan.

“When I first started doing this type of surgery, I didn’t see any patients who were minors,” said Dr. Michael Brownstein, the reconstructive surgeon who performed the procedure. “And now I see a respectable number.”

He said minors like Nathan need permission from both parents, and that Nathan had letters of referral that indicated he was capable of making the decision and that the procedure was appropriate for him.

“I think ... Nathan is going to be quite pleased,” said Dr. Brownstein.

Though the procedure costs almost $10,000, not covered by insurance, Tammy said it was worth the financial sacrifice. media:30085000

quicklist:5 title:September 2012 text:Several months later, Nathan’s chest had healed from the top surgery, and he felt comfortable enough to go for a swim for the first time in years.

“It's been forever since I've been at a pool and felt comfortable being in a pool with my shirt off, so I mean, I can't even describe the feeling,” he said.

“It’s amazing,” added Tammy. “This is exactly why, you know, we wanted to do the top surgery. We wanted him to be able to do things that kids do, and that is what he is doing now.”

“To see him smile again and be comfortable in his own skin, that’s the best,” said Jim.

When he started driving, Nathan also got a driver’s license with his new name and gender listed as male.

“New name, new gender, new everything really,” he said. media:30085143

quicklist:6 title:June 2014 text:Three years after beginning his transition, Nathan, 17, is a visibly masculine, confident young man. He returned to a large public high school and graduated, wearing the blue cap and gown designated for senior boys.

“This is how I dreamed it would happen,” he said. “I'm graduating as a boy, not as a girl like I was afraid of.”

Before he transitioned, he said it hurt to look in the mirror, but now he could do that proudly. “This is the way I’ve always wanted to look, and this is the way I’ve always imagined myself being,” he said.

“If we didn’t transition for sure, we wouldn’t either have a child or he would be a very angry person,” Tammy said. “We had a really angry girl. The more counseling we got and the closer we got to things, we saw this child blossom.”

“I know if I had to live as a girl now… I would most likely be very depressed,” said Nathan. “Hopefully not, but I most likely would have tried to kill myself.”

Looking back, he said he was grateful for his parent’s support and he also shared a powerful memory of a school counselor whose indelible words comforted him for over a decade.

Her name was Amy Spletter and Nathan, then Natalie, was sent to her office in the second grade because he had been telling his classmates he was a boy.

Transgender Teen Reunites With Second Grade Counselor Who Helped Him Get Through Life

“I remember she sat me down in her office and she said to me, ‘There's other people like you and you're not alone,’” said Nathan. “So, I always thought that was the most profound piece of advice ever and it kept me going from second grade on.”

He had lost contact with her, but “Nightline” tracked her down and soon Nathan was on her doorstep to see her and thank her after all those years.

“Look at you! Oh, my gosh!” exclaimed Amy, opening the front door with tears in her eyes. “Oh, that's my wish and my dream come true,” she said, embracing Nathan.

“You sat me down and you just told me that there were other people like me,” he told her. “I never heard that before… I thought I was the only one.”

“It has kept me going all these years,” he continued. “Just the fact that you said that to me meant so much.”

Amy said she could never forget him either and that in her twenty-year career, she kept only one file: Natalie/Nathan’s. She took it out to show him, and inside were the flyers he had made in the second grade that declared, ‘I am not a girl,’ ‘I am a boy’.

“I couldn’t do anything big,” explained Amy, “but I could be there every day when Natalie needed to talk.”

Nathan said he doesn’t want another transgender kid to have to go through life thinking they’re different or wrong. “They need that one person that says, ‘You-- you're all right’,” he said. “That's what matters, is just having one person.”

In his case, he had three: his caring parents and a counselor who made all the difference. media:30087569