Inside the Landmark, Long Overdue Study on Chest Binding
Chest binding is an everyday reality for many transgender and non-binary people, but healthcare professionals know little about the practice. The first ever medical study on the practice says that it's time to change that.
Dylan has been binding since his teens. All photos by Fox Fisher
"I remember the first time I put on a binder," recalls Naomhan, a non-binary trans activist from Belfast, Northern Ireland. "An ex-boyfriend gave me his old binder and after I put it on, I remember looking down at my chest and then into the mirror, feeling euphoria at how happy it made me feel."
Chest binding is a fact of life for many people, including trans men, some gay women, intersex people, and gender non-conforming individuals like Naomhan. Flattening the appearance of one's breasts—whether that's through Ace bandages, compression undergarments, layered T-shirts, sports bras, or commercial binders—doesn't just make it easier to pass in public as the correct gender or wear masculine clothes. For many, it's a matter of psychological well-being.
"I couldn't take my binder off except to sleep," Naomhan says. "It would be the first thing I put on when I woke up in the morning, and I would feel dysphoric even sitting at home without my binder on."
Outside of the queer community, chest binding remains a relatively unknown phenomenon. It is more commonly discussed by trans vloggers (the search term "my first binder" brings up about 114,000 results on YouTube) than it is by healthcare professionals. But new research conducted by The Binding Health Project and published in Culture, Health, and Society—which they say is the first study on chest binding published in a medical journal—shows that a discussion on how to help people bind safely and effectively is long overdue.
A qualitative report from the five-person strong research project goes into more detail about the benefits of binding for those they surveyed: "Based on our preliminary analysis, for most participants, binding was a positive experience and led to improvements in mood and self-esteem, minimized gender dysphoria, anxiety, and depression, and helped them to feel in control of their bodies," a report they published on the study reads. "In fact, some reported that a positive impact on emotional and behavioral health makes the physical discomfort of binding worth it."
"Binding is a part of daily life for many, but it can have negative impacts on your physical health—ranging from minor to severe—across a wide range of symptoms, from pain in different parts of your body, to shortness of breath, to bruising or other skin changes," explains researcher Sarah Peitzmeier. She is a member of the Binding Health Project, which hopes to "expand and contribute new information on the physical and mental health effects of chest binding." It comprises of Boston University medical students and graduates, as well as a PhD student at in public health at John Hopkins.
The researchers hope that the study will provide an initial roadmap for change, educating physicians on the benefits and impacts of binding and allowing those who bind to take charge of their health. They scoured peer-reviewed literature and information from health clinics, LGBTQ organizations, and online community resources, coming up with 28 potential health outcomes from binding. 1,800 respondents answered an online survey with questions ranging from how often they bound, what they used to bind their chests with, and their gender identity.
According to the study, binding was a "daily occurrence" for its participants. Just over half of respondents bound their chests seven days a week, with people binding for an average of ten hours a day.
Despite the ubiquity of the practice, a staggering 97.2 percent of those surveyed reported at least one negative health outcome that they attributed to binding. Seventy-four percent reported pain-related concerns—the most common side effect was back pain (53.8 percent), followed by overheating (53.5 percent), chest pain (48.8 percent), shortness of breath (46.6 percent), and itching (44.9 percent). Fifty respondents even believed they had suffered from rib fractures as a result of binding.
Though binding is an everyday reality for many queer people, there remains a troubling lack of specific medical knowledge about the practice. The trans and non-binary individuals that I spoke to often relied on the advice of trans family members and friends, online communities for LGBTQ people, and tips gleaned from vloggers—one first learned of binding from the 1999 film Boys Don't Cry. None of them had ever approached a medical professional for advice on binding, even if they were in pain from binding.
"There would be a lot of time that I would get up at six in the morning for an early [work] shift, and then I would bind after the early shift and not go to bed until two in the morning," says Dylan, a custody officer assistant from Worcestershire who has been binding since he was a teenager. "So I would be bound [sic] for like 20 hours and, you know, you do get pains and you suffer from a really bad back."
He didn't take any painkillers for his back, and said that he didn't seek medical attention. "I ignored the pain," he continues. "Just pretended it wasn't there. The doctor is just going to tell me to stop doing what I'm doing that hurts me. I don't see the point."
Dylan's suspicions aren't far off the mark. "While we don't have numbers to support this, my impression is that awareness of binding is relatively low in the medical community, and even those medical professionals who know about binding aren't really sure how to assess it clinically, what the potential health impact of binding could be, and what safer binding practices they should recommend to patients," Peitzmeier says.
In the absence of professional medical advice, unofficial guidelines such as the "eight-hour rule" have sprung up, advising people to bind for a maximum of eight hours. Even then, many don't follow the informal guide.
"Most people don't follow the eight-hour rule," says Max, a 22-year-old Manchester cafe apprentice who has been binding for a year. "Let's be real, I sure don't. It's not like we have millions of options [of different binders] to choose from."
On one occasion, Max wore their binder to sleep when they hadn't had an opportunity to change out of it. "My ribs were aching for days... I mean, binding made some days bearable for me but in the end it just makes me feel like shit. I like how it flattens my chest but it is not good for me, long-term."
Companies like Underworks seek to cater for the consumer demand for binders that are more comfortable and effective. The company boasts on its website: "Today, thousands wear a binder donated by Underworks—their first binder... We're about a full life reshaping experience."
But the research shows that commercial binders—such as those sold by Underworks—are actually most commonly associated with negative health outcomes. Participants who wore commercial binders reported 20 out of the 28 health outcomes listed in the study. Duct tape or plastic wrap—materials that people are commonly advised against binding with—were only associated with 13 out of the 28 side effects.
"We were surprised about this as well, as commercial binders I think are generally perceived as a 'safe' option in the community," says Peitzmeier. "Unfortunately, we didn't collect enough data to be able to determine why this was the case." She hypothesizes that this could be related to people using commercial binders incorrectly, "for example layering multiple binders on top of each other or using a binder that is a size too small for greater compression, which we assume is more dangerous."
In a statement given to Broadly, Underworks said, "What we find is that many that want to bind have been frustrated in the past by the methods they have used in that they did not feel bound. These include layers of sports bras or athletic shirts, etc. Coming from such a thought process, they become more aggressive in their size selection as in going smaller than they measure in the hopes that they accomplish complete flatness. This is likely the biggest issue."
Recognizing the discomfort associated with trying to achieve a completely flat chest, the company instead tries to promote a "masculine looking chest" as the goal. "We try to encourage one to only wear a garment when they are comfortable wearing," the statement reads. "Convincing the client that a masculine look is what is best rather than complete flatness has proven to be a challenge. We will continue to work as hard as we can to innovate and explore the best and safest binding options."
Many trans and gender non-conforming individuals say that they would continue binding regardless of the physical health risks. The psychological relief provided by binding—as well as the increased ability to pass in public as one's correct gender—often overweighs any potential downside. Knowing this, the Binding Health Project wants to arm both medical professionals and queer people alike with information about binding, including how best to do it, what to use, and how often.
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"Mentally, I just feel so much better [when I bind]," says Lola, a 28-year-old Londoner who works in digital marketing. Lola identifies as non-binary, and has been binding their chest "on and off" for four years. "Even when my binders were cutting into my sides so bad they left deep red marks for hours afterwards, or even making my chest sore, sometimes it was completely worth the trade-off."
"I often compare body dysphoria that trans and non-binary people go through to sleeping on a lumpy mattress your whole life," they continue. "You don't really realize how bad the mattress is until you try an amazing mattress. And then once you've tried an amazing mattress, it's even more painful to go back to what you know. Once I tried on a binder, I knew that what I long suspected and thought was definitely true: I wanted my chest reduced."
"We want folks who bind to be empowered with knowledge about the potential risks of binding and how to prevent them, so they can make an informed choice about how and how much to bind that is best for them," Peitzmeier says. "We also want medical professionals to support people who bind in making these decisions to maximize their physical and mental health and help mitigate any negative side effects that do occur."
[Binding] the only recourse I have to feeling OK in my body.
As part of their findings, the researchers recommend "off days" from binding, where possible and to use caution when wearing commercial binders, as well as advising against using elastic bandages, plastic wrap, and duct tape.
Some people have good reason to throw their binders away—both Naomhan and Dylan underwent top surgery a few months ago.
"Now that it's flat, I feel 1000 times better," says Naomhan. "I can finally look in the mirror and feel happy with my body and the way it looks. If I could've had top surgery two years sooner, I would've done it to avoid the pain of binding and the agony of chest dysphoria. But I'm here now, and I'm finally happy with my body, and that's what counts!"
Others, like Max, use alternative methods to reduce their discomfort around their chest, such as working out more. "Until I get my hormones, I'm doing exercises to increase muscle mass and hopefully reduce fat around my chest. I feel a lot better psychologically as well. I highly recommend going to gym if you can, even though it is intimidating as hell. For me, considering my body as a tool and focusing on my muscles contracting and relaxing has helped a lot."
Lola says that the physical pain of binding is worth it, though they emphasize that they see binding only as a stepping stone towards lasting treatment for their chest dysphoria. The 28 year old is currently crowdfunding, hoping to raise £6,400 needed for a chest reduction surgery.
"[Binding] the only recourse I have to feeling OK in my body. Sometimes it's very relieving and helps me feel happy and re-centered," they say. "[But] it's a temporary fix that should demonstrate to people how incredibly important it is for trans and non-binary [people] to have access to the medical treatments they need."