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Addressing chest binding in transgender and gender diverse clients

Background

Chest binding refers to the mechanical compression of breast tissue, often through the use of sports bras, ace bandages, or specialized compression garments.

Binding is most commonly practiced by female-assigned-at birth or intersex individuals who identify along the transmasculine* spectrum as a means of gender expression. It is often among the first and most important aspects of transition for those who identity as female-to-male (FTM) and is typically an interim measure for clients who desire chest reconstruction surgery.[1,2]

*Within the context of this post, the term ‘transmasculine’ is used as an umbrella term to describe people who identify as trans and who express their gender identity as masculine.[3]

Effects Associated with Chest Binding

Physical
While there is limited research on the physical outcomes associated with chest binding, anecdotal and preliminary research suggests a range of effects. They include:

  • Pain and discomfort, especially in back, chest, shoulders, and breasts
  • Dermatological symptoms including acne, itch, rash, lesions, infections, reduced skin elasticity
  • Shortness of breath
  • Overheating
  • Lightheadedness and dizziness
  • Numbness and impaired circulation
  • Exacerbation of existing conditions including asthma or respiratory infections

Mental and Emotional
Binding can help alleviate psychological discomfort and feelings of dysphoria some individuals experience in relation to their bodies and is associated with [1,4]:

  • Increased self-esteem
  • Increased confidence
  • Reduced anxiety
  • Reduced depression

Binding and Sexual Health

While the links between binding and sexual health have yet to be established,
trans clients are at increased risk for STIs and are more likely to avoid seeking care and testing.[5,6,7]

Fear of transphobic discrimination, such as having to educate providers on basic aspects of trans health, is a commonly cited reason for avoiding care.[5,6,7]  As a result, apprehension surrounding how a provider will address their binding may be yet another reason for transmasculine clients to avoid care, increasing the potential for negative sexual health outcomes.

Binding in Clinical Practice

Language
Ensure you know the name and pronoun (he, she, they, etc.) your client uses. When discussing binding or breast health, using the term ‘chest’ instead of ‘breast’ can help increase comfort and reduce feelings of dysphoria. Similarly, try to avoid referencing ‘feminine’ garments such as ‘bra’ or ‘sports bra’ and instead refer to them as the ‘method of binding’.

Breast (‘Chest’) Exams and Cancer Screenings
The Canadian Cancer Society recommends continued breast cancer screening for transmasculine clients who have not undergone chest reconstruction surgery (‘top surgery) according to these guidelines. For clients who have obtained top surgery, providers are encouraged to discuss risk factors on an individual basis.

While many clients who bind recognize the importance of breast exams and related screenings, the procedures are often emotionally painful. Ask permission to perform a breast exam (‘chest exam’) and explain why it is important. Discuss with the client the ways in which you can make it most comfortable for them.  Some clients may prefer to be talked through the procedure while others may wish for it to be completed as quickly as possible with little dialogue.

Harm Reduction
Providers should recognize binding as a practice that is integral to the well being of many transmasculine and gender-diverse clients, regardless of negative physical side effects.

As such, providers can suggest the following strategies to manage or reduce the physical side effects of binding if clients are concerned:

  • Limit binding to no more than 8 -12 hours a day or try to take regular days off from binding.
  • Never sleep with a binder or compression garment on.
  • Avoid binding with duct tape, Saran wrap, or Ace bandages.
  • Avoid using specialized compression garments (binders or compression vests) that are too small. Breathing should not be impaired.
  • When exercising, try to use a binding method that is less constrictive than what one would wear on a day-to-day basis to allow for better breathing and less overheating.
  • Make sure skin is completely dry before putting on a binder to avoid skin infections and other dermatological issues. Try to use a binder or compression garment that is made of breathable fabric.
  • Further recommendations can be found at I Heart My Chest: A Chest Health Resource for Trans* Folk (Qmunity: BC’s Queer Resource Centre)

References

  1. Dutton L, Koenig K, Fennie K. Gynecologic care of the female-to-male transgender man. J Midwifery Womens Health [Internet]. 2008 [cited 2014 Nov 7];53(4):331–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18586186
  2. Maycock LB, Kennedy HP. Breast Care in the Transgender Individual. J Midwifery Womens Health [Internet]. 2014 [cited 2014 Nov 25];59(1):74–81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24224502
  3. Transgender Health Information Program. Transgender Health Information Program: Glossary [Internet]. Vancouver Coastal Health. 2014 [cited 2014 Nov 26]. p. 1–8. Available from: http://transhealth.vch.ca/trans-101/glossary#.VHX4aGTF-Gw
  4. Nelson L, Whallett EJ, McGregor JC. Transgender patient satisfaction following reduction mammaplasty. J Plast Reconstr Eesthetic Surg  JPRAS [Internet]. Elsevier Ltd; 2009 Mar [cited 2014 Nov 25];62(3):331–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18083643
  5. Bauer GR, Scheim AI, Deutsch MB, Massarella C. Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: Results from a respondent-driven sampling survey. Ann Emerg Med [Internet]. American College of Emergency Physicians; 2014;63(6):713–20.e1. Available from: http://dx.doi.org/10.1016/j.annemergmed.2013.09.027
  6. Grant JM, Tanis J, Herman JL, Harrison J, Keisling M. National Transgender Discrimination Survey Report on Health and Health Care [Internet]. Washington, DC; 2010. Available from: http://www.thetaskforce.org/static_html/downloads/resources_and_tools/ntds_report_on_health.pdf
  7. Bauer GR, Redman N, Bradley K, Scheim AI. Sexual Health of Trans Men Who Are Gay, Bisexual, or Who Have Sex with Men: Results from Ontario, Canada. Int J Transgenderism [Internet]. 2013;14(2):66–74. Available from: http://www.tandfonline.com/doi/abs/10.1080/15532739.2013.791650

Categories: Current practice

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