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Mr Verhelst told Het Laatste Nieuws newspaper: “While my brothers were celebrated, I got a storage room above the garage as a bedroom. ‘If only you had been a boy,’ my mother complained. I was tolerated, nothing more.”

After a life of being rejected by his parents as a daughter, Mr Verhelst had hormone therapy in 2009, followed by a mastectomy and unsuccessful surgery to construct a penis in 2012. “I was ready to celebrate my new birth, but when I looked in the mirror, I was disgusted with myself,” he said hours before he died. “I do not want to be a monster.”

Jacqueline Herremans, a member of Belgium’s committee for monitoring euthanasia, acknowledged that the case posed difficult ethical questions.

“This case seems to meet the requirements of the law. But I do not yet have all the elements to say it with perfect certainty,” she said. “This is a case of conscience, a situation that raises questions. There is no immediate answer. It should begin a long process to understand.”

Wim Distelmans, a cancer specialist who carried out the euthanasia on Monday, is the same doctor who last year gave lethal injections to congenitally deaf twins who were frightened they were also going blind.

Distelmans said: “He was in a situation with incurable, unbearable suffering. Unbearable suffering for euthanasia can be both physical and psychological.”

Belgium recorded a record number of 1,432 cases of euthanasia in 2012, up 25 per cent from the previous year. It is currently deciding whether to extend the legislation to children.

With files from The Daily Telegraph