Chest binding (compressing breast tissue to give the appearance of a flat chest) is a common practice among transgender men and masculine-presenting AFAB (assigned female at birth) people.
For some trans and nonbinary people, breasts are a source of gender dysphoria, as they’re a visual reminder of a person’s birth-assigned sex (1). Binding can reduce gender dysphoria and improve mental health, but it can also cause negative physical health symptoms (2).
How do people bind their chests?
People bind in many different ways: Some people wrap their chests with elastic bandages, duct tape, or plastic wrap. Some wear a sports bra, neoprene or athletic compression wear, or layer several sports bras or shirts. Others wear commercially-available binders specially designed for this purpose (2).
Everyone binds differently. Some people bind only for special occasions, others every day. One study surveying people who bind reported that the average person bound their chest for around 10 hours per day, with the most popular methods being commercial chest binders, followed by sports bras, shirt or bra layering, and bandages or elastic materials (2).
Risks and side effects of binding
Like many things people do to modify their outward appearance (wearing high heels, or shaving facial hair), chest binding comes with some risks.
Binding can affect skin, muscles, and movement, particularly over long periods of time. Tightly covering the skin and chest with materials that don’t allow free-flowing air can create warm, moist environments for bacterial and fungal infections to develop. Wearing binders that are too tight can cause underlying tissue and muscle damage, prevent free movement, and even restrict a person’s ability to breathe.
There haven’t been many studies about the health effects of binding, so it’s important to listen to experiences of others, and to talk to your healthcare provider. (Here’s a guide for finding a trans-friendly doctor and how to seek better care from the ones you do have.)
Two studies have been completed that focus specifically on people who bind. They were cross-sectional studies, observing a specific population (people who chest bind) at a specific point in time, and were published in 2017 and 2018. Both of these studies are based on data from 1,800 responders to an online survey.
Across both studies, the majority of people (89-97%) reported experiencing at least one negative symptom from chest binding (2,3).
Common side effects of chest binding
76-78% of people in studies reported skin/tissue problems, like tenderness, scarring, swelling, itching, infections
74-75% of people reported pain in chest, shoulders, back or abdomen
51-52% of people reported respiratory problems (like shortness of breath)
47-49% of people reported musculoskeletal symptoms, like postural changes, muscle wasting, or rib fractures (2,3)
Binding isn’t all bad though—a lot of people feel better mentally and emotionally when they bind. According to these studies, chest binding helps people decrease their gender dysphoria, as well as feelings of anxiety or suicidality, while increasing feelings of confidence in public and self-esteem (2).
Risk factors for binding side effects
People who bind their chest more frequently (every day) are more likely to experience negative symptoms. For this reason, taking days off between binding may help decrease this risk. Long term binding (over years) was also more likely to be associated with negative symptoms, particularly skin, tissues, and musculoskeletal problems (2). People with larger breasts were more likely to experience skin and soft tissue issues (2).
What people use to bind their chests with is a very personal choice, and finding a standard “best type of binder” for everyone is unclear. One study showed that people who used commercial binders experienced increased risk for the highest number of negative symptoms from binding, followed by those who used bandages, and plastic wrap or duct tape (2).
The high amount of negative effects found from commercial binders in this study were a surprise to the researchers, since blogs and other informal resources dedicated to trans men and healthy binding often recommend commercial binders (2,4). This could be due to people wearing binders that are too small, wearing them for longer periods, or wearing more than one at a time. More research is needed, but if you choose to wear a commercial binder, do your research, read reviews online, and make sure it is the right size for you.
Healthcare and chest binding
The 2017 study found that almost 9 in 10 people experienced at least one negative effect from binding, and 8 out of 10 felt that it was important to discuss binding with a healthcare provider. But only 3 in 20 (15%) sought medical care for binding-related health issues (3).
Over half of participants report that their healthcare practitioner is aware that they bind their chests, but among those, less than half actually discussed their binding practices with their provider. People who felt safe and comfortable about starting a conversation about binding, were more likely to seek help for any negative binding side effects (3). This highlights the disparity between the healthcare that transgender people need, versus the healthcare that they have access to or feel safe to pursue. Almost everyone, regardless of their gender, manipulates their body to feel good, whether it’s binding, smoking, wearing make-up, or waxing their pubic hair—we all change ourselves in some way to feel like our “true selves.”
Sometimes these activities have some risks that require medical help (for example, smoking can cause lung cancer and many other health problems, or waxing your pubic hair can lead to ingrown hairs or infected follicles). There is no shame in talking to your healthcare provider if you experience any side effects. It’s your body and your life—you deserve safe and judgement-free healthcare.
People should consider both the mental health benefits and the potential negative physical symptoms when making decisions about binding (2).
Tips for healthier chest binding
Everyone binds differently, the trick is to figure out what is safest and best for you.
1. Limit the amount of time you bind. Don’t wear binders for longer than 8-12 hours. Don’t sleep in your binder. Don’t bind every day. Schedule binder-breaks/days off. People who bind their breasts more frequently, such as every day, are more likely to experience negative side effects (2,4).
2. Avoid binding while working out. This is when you need to breathe deeply, move freely, and you are more likely to be sweating. If you want to flatten your chest while exercising, try to find a sports bra that has this effect.
3. Get the right fit. If you wear a commercial binder, make sure that it fits correctly and that it is not too small. When buying a commercial binder, do some research to find the perfect binder for you. Try not to buy one that is too tight—if it causes pain, cuts/trauma, or restricts your breathing, then you need to go up a size or two. A binder should allow for breathing normally and allow for air circulation (look for breathable fabrics). Wet, clammy, sweaty skin conditions provide the perfect environment for skin rashes and fungal infections (4).
4. Don’t bind with plastic wrap, duct-tape, or bandages. These are associated with increased negative symptoms. Duct tape can damage your skin, and bandages may tighten as you move. Sports bras, layering shirts, or wearing athletic or neoprene compression gear, are the options associated with the least amounts of negative side effects (2).
5. Planning top surgery? Bind less. If you plan on having top surgery, don’t bind as as often, as this can affect your skin's’ elasticity and have surgical impacts (4,5). Some FtM (Female to Male transgender) mastectomy researchers feel that longterm binding may cause a decrease in skin quality, specifically elasticity, which can actually make performing a mastectomy more complex (5).
6. Listen to your body. If you feel pain or have any difficulty breathing, remove your binder (or other restrictive garment). Maybe what you were wearing was too tight, or you have been binding for too long without a break.
Much more research about the health and needs of transgender men and genderfluid people is needed. These populations have different healthcare needs, and everyone deserves access to adequate and personalized healthcare.
If you’re experiencing any negative symptoms related to binding, we recommend that you see a healthcare provider. Check out our guide to how to find a trans-friendly OB/GYN.
We’ve also written about gender dysphoria, how testosterone affects your period, and trans, nonbinary, and genderqueer people’s experiences of birth control.
Some people find that tracking their period can help reduce dysphoria. See our tips for using Clue when you’re trans.
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