Chest Binding: A Physician’s Guide

Transgender and gender nonbinary individuals may choose to engage in various gender-affirming practices to reduce gender dysphoria or present in a way that is more congruent with their gender identity. This article is a primer for physicians on counseling their gender-expansive patients on chest binding, a practice used primarily by transgender men and nonbinary individuals in order to achieve a flatter, more masculine chest appearance.

The mental health benefits that transgender and nonbinary individuals experience from binding are striking: according to a landmark study on binding practices in the transgender community, roughly 70 percent of surveyed individuals reported a positive mood after starting to bind compared to only about 7 percent who reported having a positive mood before binding.¹Peitzmeier S, Gardner I, Weinand J, Corbet A, Acevedo K. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Cult Health Sex. 2017;19(1):64-75. Epub 2016/06/15. doi: 10.1080/13691058.2016.1191675. PubMed PMID: 27300085. This explains why, in the same study, approximately 87 percent of transgender-identifying individuals reported using binding as a method for achieving congruence between their physical appearance and gender identity.

Safe chest binding practices

There are many resources regarding best practices and methods for binding. As a healthcare provider, it is important to be aware of the variety of binding methods and associated health risks; while binding is often essential for transgender individuals’ mental health, binding unsafely can negatively impact their physical health. Patients may come to their primary care provider having read a variety of conflicting information about binding, and being knowledgeable about resources and best practices will assist in counseling patients on how to engage in this gender-affirming practice as safely as possible.

Binding improperly or for too long can lead to chest and back pain.

It is safest and most common to bind using a dedicated binder, an article of clothing designed specifically for this purpose. Binders come in half-length or full-length styles (see below), and which style a patient chooses to use is dependent on personal preference and comfort.

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While extensive data on binding practices is lacking, most LGBT community resources recommend binding with a dedicated binder or a sports bra if a binder cannot be acquired. Wearing a single sports bra to bind is associated with fewer negative health outcomes than using a commercial binder,²Peitzmeier S, Gardner I, Weinand J, Corbet A, Acevedo K. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Cult Health Sex. 2017;19(1):64-75. Epub 2016/06/15. doi: 10.1080/13691058.2016.1191675. PubMed PMID: 27300085. however sports bras are not specifically designed for compression, and commercial binders will generally provide patients a flatter contour. Some individuals will try to use athletic bandages or even duct tape to bind their chest; these methods can be associated with a higher risk for negative outcomes, including shortness of breath, skin damage, and musculoskeletal damage. If a patient has been using one of these methods, make sure to check for evidence of these complications.

That said, even a dedicated binder is not without risk, and binding improperly or for too long can lead to chest and back pain, rib bruising and fractures, shortness of breath, overheating, and skin damage.³Peitzmeier S, Gardner I, Weinand J, Corbet A, Acevedo K. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Cult Health Sex. 2017;19(1):64-75. Epub 2016/06/15. doi: 10.1080/13691058.2016.1191675. PubMed PMID: 27300085. The following are some of the most important points to discuss with patients in order to reduce the risk of serious harm.

Binder sizing: It is important to counsel patients to order the appropriate size binder for their body. Some individuals attempt to order a size smaller than what their measurements would indicate in order to try to achieve a flatter chest. This can be dangerous, making it more difficult to breathe when wearing the binder and increasing the risk for pain as well as rib and lung damage. Most online vendors have detailed sizing guides to help people choose the size that is right for them along with instructions on how to measure accurately.

Binding duration: Peitzmeier et al.’s study on binding health and outcomes in adults showed that more frequent and longer binding sessions were associated with increased risk for negative outcomes.⁴Peitzmeier S, Gardner I, Weinand J, Corbet A, Acevedo K. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Cult Health Sex. 2017;19(1):64-75. Epub 2016/06/15. doi: 10.1080/13691058.2016.1191675. PubMed PMID: 27300085. Based on these findings and community guidelines, patients should be counseled to bind no more than eight hours per day and to take at least one day off from binding per week. This includes counseling against sleeping in a binder, which can seriously impact health outcomes. It is often difficult or impossible for patients to strictly adhere to these guidelines; in cases where a patient must wear their binder for longer, or forget to take it off, providers may recommend taking a day off from binding the following day. Additionally, if a patient knows they have a work or school day that is longer than eight hours, counseling them to take off their binder and breathe for a few minutes when they use the restroom is warranted. Finally, instruct patients to take several deep breaths after taking their binder off at the end of the day. This will allow patients to identify any pain they might be feeling and will help stretch the muscles and other structures that have been compressed all day.

Swimming or exercising while binding: There is conflicting information regarding engaging in physical activity while binding, and no study has yet addressed the health outcomes specifically associated with binding while exercising. Currently, the binder website gc2b recommends wearing a size larger while exercising, starting with low-intensity exercises, and ceasing activity with any signs of chest pain or discomfort. Additionally, some sites, such as Underworks, offer binders meant specifically for swimming (see the resources section below).

Binder care: Most manufacturers recommend against putting a binder through a washer and dryer, since the process can degrade the material, making the binder less elastic. It is instead recommended that binders be hand-washed and air dried once every few uses. Additionally, it’s important to counsel patients that washing their binder will help to prevent acne and other skin infections. General skin care such as frequent washing and moisturizing can also help prevent some of these negative skin outcomes.

Beyond binding: chest reduction surgery

According to Peitzmeir et al., roughly two-thirds of the individuals surveyed expressed interest in eventually getting “top surgery,” surgical reduction of breast tissue to permanently achieve a flatter chest.⁵Peitzmeier S, Gardner I, Weinand J, Corbet A, Acevedo K. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Cult Health Sex. 2017;19(1):64-75. Epub 2016/06/15. doi: 10.1080/13691058.2016.1191675. PubMed PMID: 27300085. Discussing the option of surgery with patients can serve as a way to mitigate the negative impacts of long-term binding, since getting top surgery would reduce or eliminate the need to continue binding. There are patients, however, who either do not want or can’t afford top surgery, which costs between $3,500 and $9,000 in the United States.

In summary, when talking to patients about chest binders, it’s important to discuss the options available, the risks involved and how to minimize them, whether they want a more permanent option such as top surgery in the future, and where and how they can acquire a binder.

Chest binding resources

Since chest binders are specialized articles of clothing, the easiest and most confidential way to acquire one is often through online vendors. Below is a non-comprehensive list of a few of the most popular and well-reviewed vendors in the community as well as a price range for their products. Many sites will also do binder giveaways for people who might otherwise not be able to afford one, and some of those are also listed here.

Online Vendors:

• Gc2b: Sells full- and half-length binders in a variety of colors, including skin tones, black, white, and other colors. (Price range: $33-35.)
• Underworks: Sells full- and half-length binders in black or white as well as binders designed to be worn while swimming, different styles of compression tops, and briefs designed to hold packing devices. (Price range: $17-85.)

Binder Giveaways:

• FTMEssentials Free Youth Binder Program: Offers free binders to individuals under the age of 24 who can’t afford to purchase a binder. Requires a brief application.
• Point5cc Free Chest Binder Donation Program: Offers free binders to transgender-identifying individuals of all ages who can’t afford to purchase a binder. Requires a brief application.