A joint project of public health and medical students at Boston University, the Binding Health Project studied the health impacts of binding.
There was large variation in how concerned participants were about the effects of binding on their physical health, with the median participant somewhat concerned (3 on a scale from 1 to 5). Self-reported mental health effects were almost universally positive, with qualitative data indicating decreases in suicidality, anxiety and dysphoria and increased self-esteem, confidence and ability to go out safely in public. Participants reported an increase in self-reported mood with binding; those reporting ‘very positive’ and ‘positive’ mood increased from 7.5% to 69.9% with binding. On average, respondents’ rating of their mood before and after binding significantly increased from a 2.1 to a 3.8 on a 5-point scale (mean difference = 1.73, 95%CI: 1.67, 1.79).
Binding was a daily occurrence for most participants, with 51.5% binding seven days per week on average (Table 2). When binding, participants bound for an average of 10 hours per day. Most participants in the sample (78%) had bound for at least a year. The median duration of binding was two years. Unbound chest size varied widely.
Binding methods were diverse, although the majority reported using a commercial binder (87.2%). Sports bras (33.1%), layering shirts (24.0%), layering multiple sports bras (18.6%) and using elastic or other bandages (16.5%) were the next most common methods.
Experiencing any health outcome related to binding was nearly universal, with 97.2% of participants reporting at least one negative outcome they attributed to binding. The most commonly reported outcomes were back pain (53.8%), overheating (53.5%), chest pain (48.8%), shortness of breath (46.6%), itching (44.9%), bad posture (40.3%) and shoulder pain (38.9%) (Table 3). Of the categories examined, skin/soft tissue and pain symptoms were most common, with 76.3% of respondents reporting any skin/tissue concern and 74.0% reporting any pain-related concern.
Odds ratios and confidence intervals for all bivariate regression models and for the 28 multivariate regression models are provided in the Supplemental Data for this paper. In bivariate analyses, binding-years was associated with 24 of 28 outcomes. Intensity was associated in bivariate analyses with 15 of 28 outcomes. However, after adjusting for binding practices, binding method and chest size in the multivariate models, intensity was only positively associated with skin infections and negatively associated with four outcomes.
In multivariate models, frequency was the factor most consistently associated with negative health outcomes (22 of 28 outcomes) (Table 4). Duration was also independently associated with 13 of 28 outcomes. Larger chest size was independently associated with higher odds of 11 of the 28 outcomes. Chest size was consistently associated with skin and soft tissue outcomes, unassociated with pain, general or respiratory outcomes and inconsistently associated with musculoskeletal, neurological or gastrointestinal outcomes. Commercial binders were the binding method most consistently associated with negative outcomes (20/28), followed by elastic or other bandages (14/28) and duct tape or plastic wrap (13/28).
Binding frequency, or average days per week spent binding, was the factor most consistently associated with risk for self-reported negative health outcomes in adjusted analyses (22/28 outcomes). This suggests that taking ‘off’ days from binding could potentially reduce risk for negative health impacts. This is notable given that over half of participants bind daily and do not regularly take off days.
Current community resources largely recommend reducing binding intensity (i.e., hours per day spent binding) to reduce negative physical effects (Hudson. 2004. “Hudson’s FTM Resource Guide”. Accessed May 22, 2015.; TransGuys. 2014. “Chest Binding 101 – FTM Binder Guide: FTM Binding.” Last modified March 29, 2016.), but our data do not necessarily support this recommendation, as intensity was largely unassociated with physical health outcomes in multivariate analyses. Based on this study, individuals may consider reducing the frequency of binding, in addition to or instead of reducing the daily intensity of binding, to minimise or prevent negative physical symptoms.
In addition to frequency, duration (number of years spent binding regardless of frequency or intensity) was independently and positively associated with 13 health outcomes, particularly skin and soft tissue outcomes and musculoskeletal outcomes. Reducing duration by delaying the onset of binding, if possible, may reduce the risk of experiencing the negative physical outcomes explored in this study. For individuals experiencing significant gender dysphoria, chest reconstruction surgery offers a way to decrease risks associated with duration and often results in improved quality of life (Newfield, E., S. Hart, S. Dibble, and L. Kohler. 2006. “Female-to-Male Transgender Quality of Life.” Quality of Life Research 15 (9): 1447–1457.10.1007/s11136-006-0002-3 [CrossRef], [PubMed], [Web of Science ®]; World Professional Association for Transgender Health. 2012. “Standards of Care for the Health of Transsexual, Transgender, and Gender- Nonconforming People; Version 7.” World Professional Association for Transgender Health. Accessed September 26, 2014.). For most, however, surgery is not always desired, can be difficult to access and often involves financial hardship in addition to the risks and recovery period that accompany surgery.
Commercial binders were the binding method most consistently associated with negative health outcomes, possibly because such binders have the potential to provide more compression than other binding methods. This finding is inconsistent with community perceptions that commercial binders represent the safest option (Cole, B., and L. Han. 2011. Freeing Ourselves: A Guide to Health and Self Love for Brown Bois. Oakland: Brown Boi Project.; Hudson. 2004. “Hudson’s FTM Resource Guide”. Accessed May 22, 2015. ; QMunity. 2013. “I Heart My Chest: A Chest Health Resource for Trans* Folk.” BC Queer Resource Centre, 5–8. Accessed September 26, 2014. ; Stanford University, Vaden Health Center. 2014. “What Are Health Concerns for Transmen?” Stanford University. Accessed September 26, 2014.; TransGuys. 2014. “Chest Binding 101 – FTM Binder Guide: FTM Binding.” Last modified March 29, 2016. ).
This study lacked sufficient detail about participants’ binding practices to determine if binders are uniformly risky, or if practices such as wearing multiple binders or overly tight binders drove the heightened risk associated with binders in this study. Elastic and other bandages, duct tape and plastic wrap were all commonly associated with negative health outcomes, a finding consistent with existing community recommendations against their use. Sports bras, layering sports bras and neoprene or athletic compression wear were the binding methods least commonly associated with negative outcomes, and therefore may be the safest options for binding.
Conclusions and Outcomes
- If possible, talk to a doctor about binding and have them help you choose the right size binder, and have them monitor your health and any negative effects.
- Sizing your binder to have a more masculine chest rather than a completely flat chest may be safer.
- Sports bras, layered sports bras and neoprene compression wear may be the safest binding options, followed by commercial binders in the appropriate size.
- Taking entire days off from binding may help reduce negative effects more than reducing hours per day.