Birkhead, the son of Larry L. Birkhead and Nancy Birkhead, is a native of Louisville, Kentucky. Birkhead has a twin brother Lewis, as well as a sister, Angela Heuser, and a half-sister, Judy Birkhead. He graduated in 1991 from Louisville's Doss High School. He holds a 1999 degree from the University of Louisville. Birkhead and Smith initially met in May 2004 at the Trish Barnstable Brown Gala, one of the major Louisville-area Kentucky Derby parties that attracts many celebrities.