A Belgian man who was born a woman has died by legal euthanasia after his sex change operations left him with "unbearable psychological suffering."
Nathan, born Nancy Verhelst, died on Monday afternoon, Belgium's Het Laatste Nieuws reported.
Speaking to the newspaper hours before his death, the 44-year-old described a troubled childhood.
He said: "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."
Verhelst had hormone therapy in 2009 and a mastectomy and surgery to construct a penis in 2012 but said "none of these operations worked as desired."
"I was ready to celebrate my new birth," he told the newspaper. "But when I looked in the mirror, I was disgusted with myself. My new breasts did not match my expectations and my new penis had symptoms of rejection. I do not want to be... a monster. "
Following his death, his mother spoke to the newspaper on Wednesday, to say Verhelst's "Death does not bother me. I feel no sorrow, no doubt or remorse. We never had a bond which therefore could not be broken."
The euthanasia was carried out by cancer specialist Wim Distelmans, who last year administered lethal injections to congenitally deaf twins who feared there were also going blind.
Antwerp brothers Marc and Eddy Verbessem had lived and worked together as cobblers all their lives and told doctors the thought of never seeing each other again was unbearable.
After the Netherlands, Belgium was the second country in the world to legalise euthanasia in 2002, but not for minors.
Prisoners are also allowed to choose death by euthanasia in Belgium. If new proposals by the Socialist Party are approved, Belgium could allow euthanasia for people under 18 and for people with Alzheimer's.
A study in 2010 revealed that more than 100 nurses in Belgium had taken part in 'terminations without request or consent'.
The Belgium-based European Institute of Bioethics highlighted the "absence of any effective control" over euthanasia in December last year, according to the Telegraph.
In the Netherlands, the patient has to be at least 12 years old to be euthanised and patients between 12 and 16 years of age require the consent of their parents.
Euthanasia is illegal in the UK and any doctor who deliberately gives patient a lethal overdose can be prosecuted for murder. This continues to be the case, however since 1993, 'assisted suicides', those which remove treatment keeping someone alive, is not illegal.
The issue came to a head this year because of the plight of "locked-in" sufferer Tony Nicklinson, who lost a legal battle for the right to be helped to end his life when he chooses. He died just days after the High Court judgement, after reportedly refusing food.