Despite removing his breasts, growing a wispy beard and legally having his gender changed from female to male, Beatie, 34, kept his female sex organs intact because he hoped to have a child some day.
After years of struggling with his sexual identity and deciding to live as a man, he did the most womanly thing possible -- he became pregnant.
In an exclusive interview with Oprah Winfrey, Beatie said his lifelong desire to have children motivated him to use his still working female reproductive organs when he learned that Nancy, his wife of five years, was unable to conceive.
"I actually opted not to do anything to my reproductive organs because I wanted to have a child one day. I see pregnancy as a process and it doesn't define who I am," Beatie told Winfrey.
"I feel it's not a male or female desire to have a child. It's a human need. I'm a person and I have the right to have a biological child."
Beatie was impregnated with sperm from a donor. His wife, Nancy, inseminated him at home with a device she said was like a syringe without the needle. They bought it from a veterinarian and it is typically used to feed birds.
He has an intact vagina, but he he did not say how he would deliver the baby.
Beatie, who was born Tracy, said he first felt he was trapped in the wrong body when he was in his 20s. He quickly went from a Miss Teen Hawaii USA finalist to taking testosterone and growing a beard.
"Sexuality is completely different than your gender," he said, responding to a question about why he did not remain a lesbian woman. "I felt more comfortable being the male gender."
"It was difficult for society to respect the way I felt inside if I didn't look like a man outside. I started wearing men's clothes and people started regarding me as a man."
Despite having two adult children from her first marriage, Nancy said she could no longer have children because she had her uterus removed.
"It wasn't difficult because I can't have children," Nancy said. "I had endometriosis and they had to remove my womb, therefore I don't have a womb."
Beatie and Nancy tried to conceive once before with him carrying the child, but the pregnancy was unsustainable because the fertilized egg had implanted outside of the uterus.
The couple had a difficult time finding a doctor who was willing to help them conceive. They saw nine obstetricians before one was willing to help them.
"People's normal perceptions are going to be challenged, but once I met Thomas and Nancy I realized they're devoted and need quality medical care like everyone else," doctor Kimberly James told Oprah.
"Thomas has been off testosterone for two years before even trying to conceive. His testosterone levels are normal. Some physical changes are permanent, but his hormone levels are normal. People ask 'is the baby going to be normal?' The baby is totally healthy," she said.
The couple's family and neighbors have reacted in different ways, some supportive, others less so. When his first pregnancy failed, "my brother said it was a good thing that it didn't happen because it would have been a monster," he told Winfrey.
Nancy's two daughters, however, are very supportive.
Neighbors, identified only as George and Victoria, from Bend, Ore., said they were more surprised that shocked.
"I was under the impression that Nancy was pregnant. I often see Thomas out and about cutting grass. Thomas told us it was he that was pregnant. I was surprised. It's not Nancy? It's Thomas. I have to get my head around this," Victoria said.
Beatie said he and his wife are legally married because Beatie is legally a man. They plan to provide a happy home for their baby girl.
"Love makes a family and that's all that matters," he said.