It went from “shaky, to unstable, to almost impossible,” for John Blanchard, a 16-year-old who came out to his parents as transgender when he was a first-year high school student.

Among several other transkids narratives, John’s story was told in a PBS “Frontline” episode, “Growing Up Trans,” which originally aired June 30, 2015. Born female-bodied Giana, to Lisa and Burt Blanchard, John recalled some of his experiences being bullied, being shut out by his father and feeling like his own body did not want him.

John’s story is reflective of thousands of transgender children in the United States, children who are inspiring new waves of research in medical and social communities across the country.

And John’s story has only begun.

“They’re a very vulnerable demographic and there’s not a lot of research on the ways trans children are affected health-wise,” said Hope Albert, ’19. “There’s only been so much information in the past decade, so using the YouTube narratives, you’re able to learn through their lived experiences.”

Albert, of Pittsburgh, is a global health studies major who knew she wanted to research transgender health trends for her senior comprehensive project while organizing her ideas during her junior seminar last year.

Developing her ideas further this year, Albert said she has now entered the analysis stage of her comp, which has since evolved from her junior seminar work to focus on transgender youth more specifically and transgender youth communities online.

The project, Albert explained, examines the narratives of transgender youth, most falling within the ages of 13 and 17, as told by them in videos posted to YouTube.   

“I’ve never been big into vlogging or YouTube, and I didn’t know how much it creates a community and how much people really rely on it,” Albert said. “You always hear about the negative stigmas around the internet and social media, but you don’t really think about how much you can create a support system and get information from it.”

Though Albert initially intended to focus on chronic disease trends among transgender youth, she said she has included analysis of noticeable topical trends on YouTube.

“Having a stigmatized identity like that really puts a toll on your physical health, mental health (and) social health,” Albert said. “(YouTube channels) are a big information hub for other kids. They talk about the medicines they’re on, the social aspects, a lot of them talk about going to school and not knowing which bathroom to use.”

Albert recalled watching “Growing Up Trans,” after it was recommended to her by Vesta Silva, associate professor of communication arts/theatre and global health studies, and said the YouTube analysis component of her comp became especially important because of the way “Growing Up Trans” is constructed.

Written, produced and directed by cisgender filmmakers, Albert said, “Growing Up Trans,” and similar documentaries do not allow transgender people full control of their own stories.  

“I wanted to look at kids telling their narrative from their perspective and not from someone else’s perspective,” Albert said.  

Silva, who serves as Albert’s first reader on her comp committee, provides a space for discussion in Communication Arts 251, gender in public communication, about how transgender identities are culturally constructed in the United States.

Research about transgender identities and issues is not new, Silva said, but the ways in which hormones are now discussed among and made available to transgender youth have not yet been fully understood by pediatric professionals or family members of transgender kids.

Relative to transgender adult issues, transgender youth issues “are more controversial” because of the role parents or guardians have to play in the decision-making process for minors and because of the debates over the appropriate “interventions for children who express divergent gender identities,” Silva said.

“Some of the research suggests that not all children who have divergent gender identities end up becoming trans adults,” Silva said. “So there’s a lot of controversy about medical interventions, (and) one of the big controversies is: Would puberty blockers be available to these families?”

Puberty blockers, also known as hormone suppressors, are often one step in a lengthy process of transitioning from one body identity to another which slow the physical manifestations of puberty. These medications, though, can cost more than $1,000 per month, total thousands of dollars each year and be subject to transgender exclusions on insurance plans.

Financial cost alone can be prohibitive for families with transgender children, and access to pediatric specialists can compound those costs, according to Silva.

Few pediatricians in the United States feel comfortable treating transgender youth, so those who do feel comfortable are typically found in urban centers, to which families must travel to receive care.   

“You add in any other kind of factor — individuals who aren’t white, individuals of lower socioeconomic status, individuals without secure home lives — and the risks of violence typically go up, the availability of medical treatment typically becomes more difficult,” Silva said.

When puberty blockers are available and attainable for families of transgender youth, the process can still be unsettling and fraught with interfamily struggle.

“Some individuals suggest that (puberty blockers) could create a much smoother life for them because they never have to develop the secondary sex characteristics of the gender they don’t identify as, but there’s definitely concern,” Silva said, pointing to a lack of new research as a main concern about the long-term impacts of pausing puberty.

The Center for Gender, Sexuality and HIV Prevention at the Lurie Children’s Hospital in Chicago is one of the leading American institutes for transgender healthcare, and teams of specialists were featured in “Growing Up Trans,” discussing options with families and transgender kids at different stages in their transitions.

While puberty blockers, like the drug Lupron, inhibit typical adolescent development, some treatments, like surgical procedures and hormonal replacement therapy, or HRT, are more permanent.

Robert Garofalo, the division head for adolescent and young adult medicine at Lurie Children’s Hospital of Chicago, met with transgender kids and their families on camera for “Growing Up Trans.”

“We’re asking families to take some leaps of faith based upon the child that they have in front of them and really what we don’t know with regard to some of the long-term consequences of these medications,” Garofalo said about halfway through the one hour and 24 minute “Frontline” episode. “We know very little about things that are really important to families like fertility, like cancer potential or oncologic potential of these agents, cardiac risk … things that families want to know when they’re making decisions about their children.”

With several medical risks not fully understood, transgender youth often face an additional obstacle to becoming their true selves: parents, who are required to sign consent forms for children and youth interested in HRT in most states.

For Laurie Singh, the mother of Alex Singh, the decision to consent to HRT was rooted in concern for Alex’s mental health, which she feared would be at greater risk had he not been given the chance to fully be himself.

“It is very, very hard to make the decision to allow your child to take a medication that has unknown side effects, but it becomes a lot easier when you come to the conclusion that the benefits outweigh the risks,” Laurie Singh told “Frontline.” “And when you see your child suffer and struggle the way we have seen Alex struggle, we don’t have a choice.”

Alex, like so many other transgender youth, have turned to online platforms, including Tumblr, Instagram and YouTube, to learn more about other transgender kids and transgender transitions.

These online communities have been at the center of Albert’s research, and YouTube vlogging communities for transgender youth and transgender issues have generated new insights into how transgender youth identities form.

Similar to patterns in “Growing Up Trans,” Albert said she has found most transgender youth YouTube personalities to be unrepresentative of transgender minorities.

“Potentially, it could be semi-harmful because (YouTubers are) coming up with the standard identity for trans kids,” Albert said. “Most of the kids that I’m seeing have family support, they’re usually from upper or middle class families, most of them are white, so it sets this standard of identity which maybe not all trans kids can relate to.”

Positive outcomes from widely viewed YouTube videos, however, should not be ignored, Albert said.

For kids like John, who begin to find it “almost impossible” to hang on, “almost impossible” to hear peers shout at him with hate and misunderstanding, online communities may serve as a haven. YouTubers may serve as role models, as virtual community organizers.

“There’s going to be a lot of positives — they’re building a community,” Albert said. “They use this community to talk about their issues, which is really helpful because it shows that you’re not alone.”