Many transgender and gender non-conforming people “bind” (or pratice “binding,” using clothing or objects to flatten chest tissue to create the appearance of a flat chest). This is typically done to reduce or eliminate the appearance of breasts in order to have a more typically-masculine appearance. (24, 25, 27)

 

Commercially produced binders are compressive undergarments designed for this purpose. Many individuals use other items to bind, including sports bras, neoprene/athletic compression wear, elastic bandages, plastic wrap, duct tape, and more. Research on the health outcomes and safety of binding has historically been very limited or nonexistent, therefor many people who regularly bind rely on community-developed precautions based on individuals’ experiences rather than scientific evidence. (24)

 

A recent study, based on an international online survey asking individuals with experience in regularly binding to self-report the health outcomes of binding, found positive and negative health outcomes of binding. (24)

 

Positive impacts of binding include:

• Decrease in suicidality

• Decrease in anxiety

• Decrease in dysphoria

• Increased self-esteem

• Increased confidence and ability to go out safely in public

• Increase in positive mood (“positive” or “very positive” mood increased from 7.5% to 69.9% when binding)

 

Negative impacts of binding include:

• Pain, including pain in the chest, shoulders, back, and abdomen

• Muskuloskeletal changes, including bad posture, shoulder joint “popping”, rib or spine changes, muscle wasting, and rib fractures

• Neurological changes, including numbness, headache, and lightheadedness or dizziness

• Gastrointestinal changes, including digestive issues and heartburn

• Respiratory effects, including shortness of breath, cough, and respiratory infections

• Skin and tissue changes, including breast changes, breast tenderness, scarring, swelling, acne, itch, skin changes, and skin infections

 

It is important to note that almost everyone who regularly binds report positive effects and at least one negative effect that they attribute to binding, with the positive mental health effects outweighing the negative physical effects. (24)

 

It is important for healthcare providers to be familiar with the potential effects of binding, consider the risks and benefits of binding for each individual patient, and to educate patients on safest binding practices.

 

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Safest binding practice:

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• Use sports bras or neoprene/athletic compression wear

  • Contrary to popular belief, evidence suggests that these binding practices are safer than use of commercial binders. However, research on the topic is very limited, and more research is needed. (24)

  • Consistent with popular belief, evidence suggests that binding with adhesive bandages, plastic wrap, and duct tape is less safe than other binding practices. (24-27)

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• Minimize the frequency (days per week) of binding​

  • Common community knowledge states that reducing the intensity (hours per day) of binding is important in deterring negative health effects. (25-27) While this may be true, evidence suggests that minimizing binding frequency is more important than minimizing intensity. (24)

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• Minimize the duration (years) of binding

  • Greater duration (years) of binding is associated with greater negative health effects. “Top surgery” (the surgical flattening of chest tissue) is an effective method of reducing duration of binding. However, not all those who bind want top surgery, and not all those who want the surgery can afford it.  (24)

 

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These findings highlight the importance of scientific research to develop safe practice standards for binding, as many individuals rely on the common knowledge shared by community members due to the lack of science-based standards of safest binding practice.

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This page last updated: 2017