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David Reimer was one of the most famous patients in the annals of medicine. Born in 1965 in Winnipeg, he was 8 months old when a doctor used an electrocautery needle, instead of a scalpel, to excise his foreskin during a routine circumcision, burning off his entire penis as a result. David's parents (farm kids barely out of their teens) were referred to Johns Hopkins Hospital in Baltimore, home of the world's leading expert in gender identity, psychologist Dr. John Money, who recommended a surgical sex change, from male to female. David's parents eventually agreed to the radical procedure, believing Dr. Money's claims that this was their sole hope for raising a child who could have heterosexual intercourse—albeit as a sterile woman with a synthetic vagina and a body feminized with estrogen supplements.

For Dr. Money, David was the ultimate experiment to prove that nurture, not nature, determines gender identity and sexual orientation—an experiment all the more irresistible because David was an identical twin. His brother, Brian, would provide the perfect matched control, a genetic clone raised as a boy.

David's infant "sex reassignment" was the first ever conducted on a developmentally normal child. (Money had helped to pioneer the procedure in hermaphrodites.) And according to Money's published reports through the 1970s, the experiment was a success. The twins were happy in their assigned roles: Brian a rough and tumble boy, his sister Brenda a happy little girl. Money was featured in Time magazine and included a chapter on the twins in his famous textbook Man & Woman, Boy & Girl.

The reality was far more complicated. At age 2, Brenda angrily tore off her dresses. She refused to play with dolls and would beat up her brother and seize his toy cars and guns. In school, she was relentlessly teased for her masculine gait, tastes, and behaviors. She complained to her parents and teachers that she felt like a boy; the adults—on Dr. Money's strict orders of secrecy—insisted that she was only going through a phase. Meanwhile, Brenda's guilt-ridden mother attempted suicide; her father lapsed into mute alcoholism; the neglected Brian eventually descended into drug use, pretty crime, and clinical depression.

When Brenda was 14, a local psychiatrist convinced her parents that their daughter must be told the truth. David later said about the revelation: "Suddenly it all made sense why I felt the way I did. I wasn't some sort of weirdo. I wasn't crazy."

David soon embarked on the painful process of converting back to his biological sex. A double mastectomy removed the breasts that had grown as a result of estrogen therapy; multiple operations, involving grafts and plastic prosthesis, created an artificial penis and testicles. Regular testosterone injections masculinized his musculature. Yet David was depressed over what he believed was the impossibility of his ever marrying. He twice attempted suicide in his early 20s.

David did eventually marry a big-hearted woman named Jane, but his dark moods persisted. He was plagued by shaming memories of the frightening annual visits to Dr. Money, who used pictures of naked adults to "reinforce" Brenda's gender identity and who pressed her to have further surgery on her "vagina."

When David was almost 30, he met Dr. Milton Diamond, a psychologist at the University of Hawaii and a longtime rival of Dr. Money. A biologist by training, Diamond had always been curious about the fate of the famous twin, especially after Money mysteriously stopped publishing follow-ups in the late 1970s. Through Diamond, David learned that the supposed success of his sex reassignment had been used to legitimize the widespread use of infant sex change in cases of hermaphroditism and genital injury. Outraged, David agreed to participate in a follow-up by Dr. Diamond, whose myth-shattering paper (co-authored by Dr. Keith Sigmundson) was published in Archives of Pediatrics and Adolescent Medicine in March 1997 and was featured on front pages across the globe.

I met David soon after, when he agreed to be interviewed by me for a feature story in Rolling Stone. He subsequently agreed to collaborate with me on a book about his life, As Nature Made Him, published in February 2000. In the course of our interviews, David told me that he could never forget his nightmare childhood, and he sometimes hinted that he was living on borrowed time.

Most suicides, experts say, have multiple motives, which come together in a perfect storm of misery. So it was with David. After his twin Brian died of an overdose of antidepressants in the spring of 2002, David sank into a depression. Though the two had been estranged, David had, in recent months, taken to visiting Brian's grave, leaving flowers and, at some point prior to his own suicide, a note.

David also had marital difficulties. He was not easy to live with, given his explosive anger, his cyclical depressions, his fears of abandonment—all of which Jane weathered for almost 14 years. But with David spiraling ever deeper into sloth and despair, she told him on the weekend of May 2 that they should separate for a time. David stormed out of the house. Two days later, Jane received a call from the police, saying that they had found David but that he did not want her to know his location. Two hours after that, Jane got another call. This time the police told her that David was dead.

Genetics almost certainly contributed to David's suicide. His mother has been a clinical depressive all her life; his brother suffered from the same disease. How much of the Reimers' misery was due to inherited depression, and how much to the nightmare circumstances into which they had been thrown? David's mutilation and his parents' guilt were tightly entwined, multiplying the mental anguish to which the family members were already prone.

In some press reports, financial problems were given as the sole motive in David's suicide. While this is absurdly reductive, it is true that last fall David learned that he was the victim of an alleged con man who had hoodwinked him out of $65,000—a loss that ate at him and no doubt contributed to his despair.

In his final months, David was unemployed—for him, a disastrous circumstance. When I first met him, seven years ago, he was a janitor in a slaughter house—tough, physically demanding work that he loved. But when the plant closed a few years ago, David never found another full-time job. And thanks to me, he didn't have to. I split all profits from the book with David, 50-50. This brought him a substantial amount of money, as did a subsequent movie deal with Peter Jackson, the director of the Lord of the Rings trilogy. With no compelling financial need to work, David was able to sit around his house and brood—a state of affairs for which I feel some guilt.

In the end, of course, it was what David was inclined to brood about that killed him. David's blighted childhood was never far from his mind. Just before he died, he talked to his wife about his sexual "inadequacy," his inability to be a true husband. Jane tried to reassure him. But David was already heading for the door.

On the morning of May 5, he retrieved a shotgun from his home while Jane was at work and took it into the garage. There, with the terrible, methodical fixedness of the suicide, he sawed off the barrel. Then he drove to the nearby parking lot of a grocery store, parked, raised the gun, and, I hope, ended his sufferings forever.

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