Hi Alice,

I identify as transgender (ftm) and have recently begun binding my breasts using a commercially-available breast binder. I bind more or less all the time, except for when I'm sleeping. Although I know that the breast tissue will eventually break down some, what are other things that I should expect to happen? What should I watch out for? Are there any health problems that I'm more prone to as a result of binding?

Thanks!

Dear Reader,

Layering, wrapping, compressing, binding (as you mention) is a process that many female-to-male transgender (FTM) people engage in to reduce the appearance of breasts. It involves the compression of chest tissue through a number of methods (such as layering sports bras, using commercially made breast binders, and wrapping ace bandages). In fact, one study of 1,800 FTM participants found that 51.5 percent reported daily binding. While research shows that binding may promote mental health among transgender and gender non-conforming people, it possibly leads to negative physical health symptoms such as abnormal lung functioning and dermatological issues. Read on to learn about the effects of breast binding, various methods of compression, and how a health care provider may be able to support you.

In the process of binding, some people may over-compress their chests, often in an effort to achieve quicker results or “pass,” which is to be generally recognized in a way that is in alignment with their gender identity. However, this can result in a number of negative health effects. Binding too tightly may inhibit the amount of air in the lungs, resulting in dizziness and difficulty breathing. Binding that’s too tight may also cut or irritate the skin, cause back pain, and distort spinal alignment. Many people also adopt a slumped posture in an effort to hide their breasts, which might make it harder to breathe easily and result in possible headaches and back pain. Over time, continued breast binding can make breast tissue elongated and more malleable, actually making compression easier. However, studies indicated that people who bound their breasts more frequently were more likely to report negative health effects. 

The potential effects of breast binding depend, in large, on the method used. It’s recommended that binding material be able to wick away sweat to reduce the skin’s susceptibility to sores and irritation. One lower-cost binding material is neoprene, a synthetic rubber used to make wetsuits. Unfortunately, neoprene doesn’t allow much airflow through the fabric, possibly causing acne, rashes, cuts, and chafing. To minimize irritation, some use talc or other powder to help keep the skin drier and less irritated, or wear a T-shirt under neoprene binders. Methods that have been found to work particularly well for those with smaller breasts (leading to less sweat buildup) include wearing the top portion of control-top pantyhose over the chest or wearing several layers of sports bras or shirts.

While there are certain methods of compression that aren’t recommended, these guidelines aren’t "binding." For example, elastic bandages have been found to cause injury and be uncomfortable when used for breast compression. That being said, some prefer to use them as they're inexpensive and were, at one point in time, the most accessible products on the market that could be used for this purpose. For those who prefer to use elastic bandages, consider choosing one that’s wide, being careful not to wrap too tight to allow for free movement and easy breathing. Commercial binders are another controversial method of binding. Compared to other methods, commercial binders allow for the most compression. Although effective in reducing the appearance of breasts, commercial binders have been found to be the binding method most consistently associated with undesirable side effects. However, this finding is inconsistent with community perceptions, which view commercial binders as the safest option for use. 

All of this being said, the studies that demonstrated that breast binding may have health risks on physical health also demonstrated that it can be really beneficial for mental health. In fact, participants in these studies indicated that they felt the negative effects they experienced were outweighed by the positive emotional effects, as it improved their feelings of safety, anxiety, dysphoria-related depression, and their overall well-being. As such, it's not recommended for providers to consider the physical effects over the mental health effects unless the binding is causing severe injury. 

Given the uncertainty surrounding the most effective and lowest risk method of breast binding, you may consider consulting with a health care provider, who can help you decrease the likelihood of negative outcomes associated with binding. They may recommend taking ‘off-days’ from binding, limiting the hours per day, avoiding elastic bandages and duct tape as binding methods, developing good hygiene to avoid skin issues, and treating side effects as they arise. Health care providers may also want to discuss general breast health and could advise you to perform self-examinations in order to detect changes in breast tissue. Additionally, breast cancer screenings are still recommended. Finally, they might be able to offer you information on top surgery (a procedure that removes breast tissue), if this is something you’re interested in or working toward.

As you might know, it can be difficult for transgender and gender non-conforming people to find a provider who makes them feel safe and comfortable. For this reason, many don’t seek care prior to binding or in response to binding-related symptoms. You may find it helpful to seek out providers who are non-stigmatizing, sensitive, and knowledgeable about the benefits and potential complications of binding. The Gay and Lesbian Medical Association and World Professional Association for Transgender Health are two resources you may utilize to find a health care provider who’s right for you. These organizations maintain a provider directory for those familiar with and able to address the specific needs of transgender patients. If you're a college student and you'd like to use the health services on your campus, you could look to see if any of the providers on your campus indicate transgender health as a specialty. This information can often be found on the campus health services website. 

All in all, binding often does work to compress chest tissue and reduce the appearance of breasts, but can also result in some health concerns. You're wise to ask these critical questions and utilize the resources available to you in order to balance both your physical and mental well-being. Keep it up!

Alice!

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