For years, Madeline Conklin tried everything she could to keep the feelings at bay. From playing video games to spending time with friends, nothing seemed to stave off the nagging sense that she was ignoring something essential to her identity.

Tall and lithe with wavy, dirty-blonde hair that falls just past her shoulders, the 22-year-old Madison resident finally came out as transgender last month, about two years after her chest hair first grew in and she began to realize she needed to make a change.

"I used to spend my time doing other things and it would distract me but the feeling would come back. I would basically try and have as little time between doing other things as I could," she said. "It's like a baseline constant that you don't like your body."

Conklin, who was born physically male, began cross-gender hormone replacement therapy on Christmas Day, embarking on the ongoing process of transitioning to female.

She says the journey has been a generally positive one so far, though she has decided to withdraw from classes at the University of Alabama at Birmingham and move in with transgender and trans-friendly peers next month in Atlanta, which she describes as having a more robust LGBTQ community than Alabama.

"I had a really good experience at a convention in Atlanta where I was presenting female and it kind of gave me the push to just go ahead and come out," she said. "I'm out to all of the friends I care about. I haven't had one negative response."

A harrowing trend

Conklin is aware that her largely positive experience coming out as transgender is a far cry from the horror stories lived by many young transgender individuals across the state and the nation.

In December, Ohio teen Leelah Alcorn wrote a note on Tumblr decrying her parents' refusal to accept her transgender identity and criticizing societal attitudes toward transgender people before she committed suicide by walking in front of a moving truck.

But Alcorn's story is not unusual. Blake Brockington, a transgender 18-year-old once crowned king of his Charlotte high school's prom, killed himself on March 23. Ten days later, transgender 16-year-old Taylor Alesana, of Fallbrook, Calif., killed herself in the face of persistent bullying by her peers.

Nationwide, more than 50 percent of transgender youth attempt suicide at least once before they turn 20 years old, according to the Youth Suicide Prevention Program.

The Gay Lesbian and Straight Education Network (GLSEN) released a study in October that showed that 63 percent of LGBTQ schoolchildren surveyed in Alabama said they regularly heard negative remarks about transgender people in 2013. The results of an online survey conducted the same year by the Alabama Safe Schools Coalition found that of 402 Alabama high school students who responded, 28 percent "heard derogatory language about someone's gender identity multiple times each day."

Huntsville 16-year-old Cecil Eady identifies as agender and prefers to go by the pronoun "it," rather than "he" or "she." Eady says that falling under the transgender umbrella attracts hurtful bullying at school.

"People like me who do weird stuff, like have hairy legs, get comments, and you still hear the F-word a lot," Eady told fellow LGBTQ youths two weeks ago during a support group meeting facilitated by the Free2Be LGBTQ Resource Center in a low-slung brick building just off Huntsville's Memorial Parkway.

GLSEN's nationwide survey of 7,898 LGBT middle and high school students revealed that 43 percent of Alabama respondents said they had been verbally harassed based on the way they expressed their gender, while 26 percent said they experienced physical harassment and 14 percent reported being physically assaulted because of their gender expression.

Those rates are similar to national averages - 55 percent of LGBT students across the country reported being verbally harassed, 23 percent reported being physically harassed and 11 percent reported being physically assaulted because of the way they expressed their gender, according to GLSEN.

Murder of transgender women of color in particular is a concern across the United States, which saw seven transgender women killed in the first seven weeks of 2015.

Alabama workplaces are not barred from firing or choosing not to hire people because of their gender identification or expression. It is more difficult in Alabama than in numerous other states to change one's gender marker on various forms of state identification. And the state has not enacted a law passed by an increasing number of states prohibiting bullying of students based on their gender identity.

But the issue has led to a patchwork of responses across the nation. Some states present more challenging environments than Alabama. The Florida legislature is considering a law barring people from using bathrooms that do not match their "biological gender." In Tennessee, it's more difficult to change one's official gender designation.

Federal laws provide some protection, as shown by a case resolved earlier this month in Huntsville. The Equal Employment Opportunity Commission awarded Tamara Lusardi, a transgender civilian employee at Redstone Arsenal, an unspecified settlement, ruling that she "was subjected to disparate treatment on the basis of sex" when she was forced to use a unisex bathroom and referred to with male pronouns at the Army facility.

Affirming steps

The more than 15 transgender individuals AL.com spoke with across the state over the past three weeks attend private high schools and public colleges, are retired and hold down jobs at big-box retailers and Starbucks locations.

They are single and in committed relationships, are grappling with whether to come out as transgender and have long openly identified as such. They identify as heterosexual, homosexual, bisexual, asexual, pansexual and somewhere in between.

They attend support groups, one-on-one therapy sessions, LGBTQ centers and advocacy events. They have been ridiculed and embraced by their peers and rejected and accepted by their families.

Hannah Loeb says the first time she took a concrete step toward presenting as female came when she purchased bottles of red and black nail polish at Target and Hot Topic stores in her hometown of Montgomery. She left the lacquers in her car under the hot Alabama sun, and they went bad before she could use them, a risk she had not foreseen given her lack of experience with beauty products.

But simply having the tiny bottles of polish in her possession, she said, filled her with a sense that she was taking ownership of her identity. She proceeded over the ensuing months to purchase and begin wearing feminine clothing and makeup and allow her dark, curly locks to grow long.

Loeb attended the private St. James School in Montgomery through spring 2013, when she decided to transfer to Indian Springs School in Birmingham in order to avoid the bullying she endured at St. James, where the teen was not out as transgender and was still perceived as being male.

Indian Springs fostered an environment that helped Loeb feel comfortable enough to come out as transgender last month, just two years after she says she heard the term for the first time and realized there were other people like her in the world.

In the few weeks since making the announcement, which she later extended to her peers in Montgomery, Loeb says she has been pleasantly surprised by how accepting the response has been.

"I thought it would be positive but I never imagined this positive," Loeb said. "The speed at which [my friends] have adapted to it is impressive. Even some of them are impressed by it. And some of them have expressed how impressed they are with the way the school's acted. Of course if I went to a rural high school I might not get the same response."

An ongoing battle

Junea Childers is a veteran of both the U.S. military and the Alabama transgender community. Now 52 years old, the Empire resident came out as transgender 27 years ago, and she has been undergoing cross-gender hormone replacement therapy for nearly 14 years.

Childers first publicly presented as female during the 1983 conflict in Beirut, Lebanon, where she served as an operations specialist in the Navy's intelligence corps, stationed offshore on the U.S.S. Iwo Jima. For nine months, her job required her to line up missile and gunnery targets, but one day she drove into Beirut wearing women's clothing and went shopping at the military mall, reprising a role she had played ever since she began wearing her sisters' dresses in elementary school.

Though Childers says she has had an inkling of her true gender identity since she was a child, she didn't have the confidence to openly express it again until around the year 2000, when she first got an Internet connection and started meeting like-minded people in Yahoo! chatrooms.

For her, being out as transgender represents the culmination of a long, difficult process. Having been subjected to numerous derogatory statements over the years, Childers emphasizes that transgender people need strong support networks to help them through the difficult times.

"A friend helped me get my look together and get my confidence up," she explained. "Sure, you may not be able to get your family or people you know on your side, but try and find some friends you can talk to."

And though some people, like Conklin and Loeb, quickly find acceptance when they come out as transgender to their family and peers, many others are ostracized and condemned. Advocates say that holds especially true for black Alabamians and transgender individuals who live in more rural areas.

Angel, a student at Lawson State Community College in Birmingham, has been subject to hate from strangers, peers and family members alike. The 18-year-old Tuscaloosa resident, who identifies as a gender-fluid pansexual and prefers the pronouns "they" and "their," says that being both transgender and African-American has made life extremely difficult.

"For me it's a constant struggle because in school and my home life I can't just be who I want to be. You've got to put on and take off a mask," said Angel, who suffers from a mood disorder and clinical depression. "It's really different for black folks. It's a slave mentality because during those times black people were meant to be so strong, and mental illness and different ways of identifying are not part of the culture."

Web of support

While coming out as transgender continues to expose Alabamians to a range of potential indignities and dangers, a growing web of resources and professionals has emerged in recent years to help members of the transgender community.

Licensed professional counselor Mary Collins of Mobile says that southern Alabama has long suffered from a dearth of sex therapists, especially ones with experience with the transgender population. Over the past three years, she has become a go-to practitioner for transgender people in the region.

"Part of the counseling is that quite a few people believe that once I start these hormones or once I change my gender everything will be better but the truth is that's not always the case," she said. "Going through the process is very difficult and some of the issues that were there are still there. Support groups are very important, being connected to other people in the community who have gone through transition."

For the past three years, the Magic City Acceptance Project (MCAP) has been a trailblazer in providing training and education about LGBT issues to members of the Birmingham community. Building on the successes of groups like MCAP, the Magic City Acceptance Center (MCAC) launched last year to provide area LGBTQ folks with an assortment of services that go beyond those offered by other organizations in Alabama.

From hosting a recurring transgender support group to backing a traveling photography exhibit raising awareness about the transgender community, MCAC is increasingly working to better transgender people's lives via means that are rare or nonexistent elsewhere in Alabama.

"We see a problem, and then we create or we find programs that fit that problem," said Karen Musgrove, executive director of Birmingham AIDS Outreach, which established MCAP in 2012. "I do believe that Alabama as a whole is becoming more accepting, but I think we have a long way to go."

Glenda Elliott, former chair and current member of the coordinating committee for the Alabama Safe Schools Coalition, which works to eradicate bullying, says public attitudes are shifting.

"It's a relatively new phenomenon in terms of general public awareness. We've known about the needs of gay and lesbian youth for some time, but we've just added trans in the last few years. It's just more visible than it's been in the past," she said. "But I think we're making some progress, I really do. We've seen it over the years. We've made a lot of progress."