Binding

Motivations for Binding

Trans individuals use binding to achieve a variety of goals. Many people begin binding as a way to explore an emerging or evolving gender identity, allowing them to literally “try on” a more masculine appearance. For some, gender dysphoria related to their chest can be reduced by minimizing the appearance of the chest. For others, binding may be less about managing an internal sense of dysphoria and more about managing other people’s reactions to them. By appearing more masculine, binding may allow the wearer to avoid being misgendered or even allow them to avoid verbal or physical transphobic violence. Particularly for individuals who have undergone masculinizing hormone therapy or otherwise appear masculine but have not had top surgery (i.e., double mastectomy), binding may allow them to move safely throughout the world or [Page 77]avoid being outed to their employer or other individuals.

Health Impacts of Binding

In addition to reducing gender dysphoria, binding has been reported to reduce anxiety, depression, and suicidality for many individuals, as well as generally improved mood and quality of life. This makes binding critical for mental health and safety in many individuals. Unfortunately, binding often has negative physical health impacts. In one study of 1,800 trans individuals who practiced binding, 97% reported at least 1 of 28 negative symptoms related to their binding, although these symptoms ranged from severe symptoms like rib fracture (3%) to symptoms of potentially minimal clinical importance, such as bad posture (40%). However, 74% reported experiencing binding-related pain in their shoulders, back, chest, or abdomen. Other symptoms included overheating (54%), shortness of breath (47%), lightheadedness or dizziness (28%), and scarring (8%). Skin changes (15%) caused by binding may be particularly concerning for trans individuals who hope to undergo top surgery, as changes to skin elasticity can compromise surgery outcomes. Individuals with larger chest sizes appear to be at greater risk of skin-related problems as a result of binding. Most of the 28 symptoms studied appear to emerge relatively quickly, within the first year of binding. Pain intensity appears to get worse on average over the course of several years.

Safer Binding

There is currently limited evidence indicating which binding practices are safer and which are more likely to cause physical harms. It seems clear that duct tape and elastic bandage wraps are some of the riskiest binding methods. While binders are perceived to be a safe option by the community, their use is still associated with many physical symptoms. More work is needed to understand whether this finding is driven by unsafe binder use (e.g., wearing two binders at once or wearing a size too small) versus using a single, appropriately sized binder. The safest binding methods may be those that offer less compression, such as sports bras or shirt layering. However, these methods may not offer sufficient compression to meet every individual’s goals around gender, mental health, and safety.

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