Binding | Transgender, non-binary and gender diverse children

coloured background and title of post on binding
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photo of Felicity St John

This blog post is a part of the resource – Supporting Transgender, Non-binary and Gender diverse Children & Young People, created by Felicity St John and Felicity’s collaborator and fellow Master of Sexology student Lindsay SmithFelicity, during a placement with Sex Ed Rescue in 2024.

Felicity St John has a Master of Sexology (Professional) with Distinction and a Bachelor of Human Services – Child and Family Studies. She currently works for an NGO as a supervisor of four practitioners, coaching and case managing families facing complex challenges. Felicity also offers professional development and consultancy. Her professional interest areas are sex education, puberty, LGBTQI+ people, child development, transgender/non-binary/gender-diverse people, relationship coaching, family coaching, and parenting psychoeducation. Felicity has a passion for supporting people to step into their capacity. When she’s not working Felicity loves to laugh, play, be with loves ones, rock climb, SUP board, explore nature, read, write, hike, cycle, swim, and laze about like a cat. You can contact Felicity via email.

Some transgender/non-binary/gender-diverse (TGD) people bind their chests. Binding is when people use materials to compress their chest tissue. This makes the chest tissue sit flatter. Binding often starts during the adolescent years.

People bind their chests with commercially bought binders, sports bras/tops, activewear, tight clothing, layering shirts/active wear, tape, compression bandages, and other materials. Some options are safer than others.

It is very common for transgender people assigned female at birth (AFAB) to bind during their lives due to gender dysphoria related to their chest development. This is sometimes referred to as chest dysphoria. Having chest dysphoria is associated with suicidality, not exercising, not playing sport, greater depression, greater anxiety, and distress. Higher rates of chest dysphoria are correlated with lower life satisfaction scores.

Research indicates that most transgender/non-binary youth who bind would like to proceed with chest/top surgery. 

People bind their chests for a variety of reasons. These include:

  • Gender affirmation.
  • To reduce gender dysphoria.
  • To explore their gender.
  • To be able to participate socially in their gender.
  • To increase safety.
  • To feel authentic.
  • To improve social acceptance.
  • To sustain their employment.
  • To reduce incidences of being misgendered.
  • Embodiment.

Binding is associated with many positive outcomes:

  • A reduction in suicidality.
  • A reduction in anxiety.
  • A reduction in depression.
  • An improvement in mood.
  • Improved self-esteem.
  • Increased social safety.
  • Less misgendering.

Because binding can have such a positive impact on mental health, some researchers and advocates consider it to be a medical device. They advocate for access, medical psychoeducation, and insurance to support safer binding.

The SOC 8 recommends that health care professionals provide psychoeducation on binding to trans youth as part of gender-affirming medical care.

In research on negative symptoms experienced by trans masculine adults when binding, most trans men experienced negative symptoms from binding. Fortunately, the more severe negative symptoms, such as rib fractures, were rare and took longer to develop.

Negative symptoms included:

  • Pain: back pain (53%), chest pain (48.8%), musculoskeletal pain, chronic pain.
  • Shortness of breath (46.6%).
  • Overheating (53.5%).
  • Poor posture (17%).
  • Skin irritation.
  • Skin changes (low prevalence).
  • Respiratory infection (low prevalence).
  • Muscle wasting (low prevalence).
  • Breast/chest changes (low prevalence).
  • Scarring (low prevalence).
  • Swelling (low prevalence)
  • Rib fractures (rare 2.8%).
  • Skin infection (rare 5.3%).

Because rare severe negative symptoms are more likely when binding has been occurring for many years, and long-term use could damage the skin, compromising chest/top surgery outcomes, these are important considerations for timeframes and support for accessing chest/top surgery if this is wanted.

If young people have access to puberty blockers at the relevant stage of puberty, followed by ongoing masculinising hormonal affirmation, they may never develop breast tissue. This means there would be no need for binding, no binding-related negative symptoms, and no need for chest/top surgery.  

So far what we know about binding safety is:

  • Duct tape is an unsafe material for binding. 
  • First aid bandages are unsafe. They increasingly tighten when worn.
  • Commercial binders, which are the right size for the person (not too small or too tight),are a safer material to bind with. The person should be able to breathe.
  • Reducing binder use to 8 hours per day is associated with a reduction in negative symptoms. Though due to the levels of distress experienced for some TGD youth in not-binding, youth will often wear their binders for longer than this.
  • Taking day(s) off during the week is associated with reduction in negative symptoms. Though due to the levels of distress experienced for some TGD youth in not-binding, youth will often wear their binders every day.
  • Pain intensity from wearing binders is increased when binding for longer durations. Pain intensity peaked after more than five years of binding. 
  • Wearing a binder during physical activity may decrease exercise capacity, but the decrease in exercise capacity is insignificant.

While many trans men who were using binders reported seeing help-seeking around binder use as important, help-seeking around binder use was low. Sometimes medical practitioners may not have the skill set or recognise the importance of providing formal guidance. 

Parents can be a barrier to young people accessing binding. Caregivers can support TGD youth around binding by:

  • Do not ignore your child’s desire to bind. Your child may bind even if you don’t want them to because they want to decrease their distress. They may seek inaccurate information that leads to less safe binding. 
  • Learn about binding and how to bind in a safer way. Young people reported learning about binding online, including from communities and peers. Unfortunately, this can lead to young people using less safe binding practices, which can lead to more negative symptoms and damage.
  • Help your young person to obtain safer binders, such as commercial binders. When left unsupported by parents, youth may resort to using unsafe household items to bind, to try to manage their distress and to be themselves. If finances are a barrier, there are some organisations where people can access donated binders.
  • Have more than one binder, as binders need to be washed.
  • Learn how to measure and fit your child for a binder if they want this support.
  • When your child grows, support them to access a commercial binder that fits them in their new size.
  • Affirm your child’s gender in other ways which support their emotional well-being. Such as using their pronouns, supporting them in accessing clothing and hairstyles that align with their gender, and using their name.
  • Support the person in accessing gender-affirming medical care if available.
  • Ask what language the person wants to use when discussing their chest. Using the word breasts may lead to feelings of dysphoria. 
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Resources

Some professional binders/binders shops

Donated binders

Donate binders to someone else

Binder Recycling/Clothing Swaps

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References

  • Binding by Trans Hub 2021.
  • Chest Binding and Care Seeking Among Transmasculine Adults: A Cross-Sectional Study. Transgender Health by Jarrett et al., 2018.
  • Chest Binding: Sociodemographic Characteristics Among a National Sample of Transgender and Gender Diverse Adolescents by Bishop et al., 2024.
  • Impact of Chest Binding on Exercise Capacity in Transgender and Gender-Diverse Youth Assigned Female at Birth by Voss et al., 2024.
  • The Binding Practices of Transgender and Gender-Diverse Adults in Sydney, Australia by Simpson & Hair 2019.
  • The Impact of Chest Binding in Transgender and Gender Diverse Youth and Young Adults Julian et al., 2021.
  • Time to First Onset of Chest Binding–Related Symptoms in Transgender Youth by Peitzmeier et al., 2021.
  • Top Surgery and Chest Dysphoria Among Transmasculine and Nonbinary Adolescents and Young Adults by Ascha et al., 2022.

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Felicity St John holds a Master of Sexology (Professional) with Distinction and a Bachelor of Human Services – Child and Family Studies. She supervises a team in an NGO, coaching and supporting families with complex needs, and offers professional development and consultancy. Her interests include sex education, puberty, LGBTQI+ inclusion, child development, and family coaching. Outside work, Felicity enjoys time with loved ones, outdoor adventures, and creative pursuits.
You can find Felicity at LinkedIn - https://www.linkedin.com/in/felicity-st-john-726365256/