Breast Binding – Self Harm or Gender Care?

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What is binding?

Binding is the practice of flattening breasts with constrictive materials to give the impression of a flatter, more masculine appearing chest. It is most commonly associated with those who identify as transgender, though it has also been a wellknown practise of women wishing for a more androgynous or male physical appearance, or to avoid unwanted attention to their female bodies. 

How is it done?

There are several methods used, which provide varying degrees of flattening. Some have very few side effects, others can be quite dangerous. 

Layering

Arguably the least harmful form of binding is the layering of clothing – vests, t-shirts and shirts – to give a flatter chest contour. It is reported to be problematic in warmer weather, when difficulties with overheating can occur.

Sports or compression bras

Compression, or high impact, sports bras can also be used to reduce the appearance of breasts and as they are designed to support the breasts during sport, are likely to be safer than purpose made binders, bandages or tape. They can be purchased in many high street clothing stores.

Bandages

Elasticated or non-elasticated bandages are wrapped tightly around the torso. This can be quite dangerous, as they encirculate the rib cage and are reported by binding women to cause problems with breathing, bruising and musculoskeletal problems.

Tape

Kinesthetic tape, or K-tape, is designed to prevent or assist in the recovery of sports injuries, but has been repurposed to tape the breasts tightly to the chest wall, often by pulling them down and towards the armpit, but sometimes by wrapping tape around the entire torso. A recent addition to the trans accessory market is Transtape – kinesthetic tape with trans branding. As an alternative, there are reports of duct tape being used, with reported consequences such as skin tearing and breathing difficulties. 

Binders

These are purpose made garments, often with a double layer of non-stretch fabric at the front, designed to give a significant degree of flattening. They have been shown to be the method most likely to have side effects, despite being widely recommended as the safest option. Purpose made binders can cost anywhere from £25 to over £50, depending on the brand and type. 

Commercially available binders have been shown to be the method most likely to have side effects, despite being widely recommended as the safest option.

Binders cannot be bought in High Street shops in the UK, so most are purchased online from a growing number of dedicated outlets such as GC2B, F2MBinders and T Kingdom. Spectrum Outfitters and Trans Shop UK are both UK based retailers. Binders are also sold on eBay and Amazon, often at vastly lower prices than the dedicated websites; but even the most committed advocates of binder use advise steering clear of these, citing the detrimental effect of too little give in the fabrics. Whether they truly do cause more harm than the more expensive versions remains to be demonstrated, as no studies have ever compared the two. This advice mainly comes from online forums or YouTube reviews.

The Half Kenny Binder from GC2B

There is also a growing demand for ‘pre-loved’ binders, and there are several online groups who will provide new or used binders to those who cannot afford one. G(end)er Swap describes itself as a clothing outreach organisation, and distributes GC2B binders online and at pop-up event shops. They also have a Facebook page for swapping clothing and accessories (including binders). G(end)er Swap state that they will not supply under 16s, but other organisations, such as MORF in Manchester, were exposed in the press for sending a binder to a child of 13, despite making clear statements on their website that they are an organisation for over 18s only. In a statement on behalf of MORF, a spokesperson for the LGBT Foundation described their actions as “sensible, compassionate advice”. In Scotland, Scottish Binders supply binders to residents of Scotland who don’t have the means to purchase a new one, and make it clear on their website that they do not have a lower age limit.

Why do girls and women bind?

Throughout history many women passed themselves as men, mostly as being female would have precluded them from pursuing their desired career or their ambitions. Binding or disguising their breasts would have been an integral part of this disguise. It was also undertaken to comply with cultural gender norms or to fit with societal views of fashion. A number of lesbian women have long used binding in one form or another, in order that gender-non conforming clothing fits their female figure in a more comfortable way, masculine clothing not being made to fit female hips or breasts. Girls have also been known to bind their breasts as a feature of body dysmorphic disorder. But the use of binding has really taken off in recent years amongst the cohort of adolescent girls who have declared a transgender identity.

Many trans-affirmative organisations report that breast binding reduces dysphoria, a feeling of intense unhappiness about their natal sex, and hence improves psychological wellbeing and reduces suicidality. But there is no research to prove this. In fact, there is very little research into this area at all.  Even some girls who have not expressed much discomfort with their breasts at all are choosing to bind because this is seen as an expression of their transgender identity, and indeed a necessary part of their transition.

What does the research say?

Binding is proposed as the only way to relieve ‘chest dysphoria’, a severe discomfort with one’s breasts, until surgical interventions can remove the source of the distress altogether. It is claimed by many trans-affirmative organisations and the wider trasgender community that binders improve wellbeing, can reduce suicidality and are essential to the mental health of young girls and women with a trans identity. Spectacular claims, with very little evidence-base to back them up.

The largest study into the side effects of binders was conducted by Peitzmeier et al. In this study of 1800 adult natal female participants, the majority were trans identified, though some did identify as female. Most were planning on having a mastectomy, and over 200 already had; only 232 were not considering ‘top surgery’. In an article for allure, lead researcher Sarah Peitzmeier is quoted as saying:

“For those with intense dysphoria, we saw that binding might dramatically reduce suicidality, anxiety, depression, and dysphoria. It could be literally lifesaving for them.”

This is a surprising conclusion to draw from this study alone, as the single question they asked about mental health did not specifically investigate suicidality, anxiety or depression, used no validated psychological measures of these symptoms, but simply asked respondents to rate their overall ‘mood’ on a scale of 1 to 5, very negative to very positive. They compared the ratings before and after binding and they did find a statistically significant increase in self-reported mood after binding, from an average rating of 2.1 before to 3.8 after. But the word ‘mood’ can be widely interpreted, and is certainly not an objective measure of suicidality.

Very recently, two studies have been published in Paediatrics, the official journal of the American Academy of Paediatrics. Mehringer et al looked at chest masculinising surgery, rather than binding, but in the sample of 30 (aged 13-21) it was reported that discomfort around their breasts resulted in negative emotions and suicidal ideation. They concluded that a double mastectomy in adolescence (under 18) could alleviate suffering and improve functioning. Peitzmeier et al (2021), took a further look at the results of ‘the Binding Health Project’ and found that most symptoms occurred within the first year of binding. They concluded that puberty blockers would delay the start of binding and reduce side effects. A bold assertion now that the UK high court has deemed young people unable to give informed consent to their use.

Any positive effect on mood in women who bind is attributed to a reduction in dysphoric feelings brought about by the masculinisation of their appearance and the subsequent increase in their passing. But could there also be another explanation? Temple Grandin, well-known author and public speaker, first raised the possibility of deep pressure having a calming and anxiety-reducing effect on autistic individuals. Deep pressure feedback is often recommended by occupational therapists for those with autism, to reduce anxiety and promote self-regulation. It is common for weighted blankets to be used to help people with sensory difficulties, and even specialised pressure vests that can be bought, which bear more than a passing resemblance to some binders. When we know that many of the young people now identifying as trans are on the autism spectrum, could it be that the deep pressure feedback these young people receive from their binders is the source of anxiety relief, rather than any feeling of passing? Could we use less constrictive means to produce the same effects?

A pressure vest from Squease.com

What are the harms?

The increase in adolescent girls using binding methods, at a time when their physical bodies have not yet matured, may well come with an increased risk of permanent damage. The effects of breast binding before the heart, lungs, spine and ribcage have had time to mature is just not known. There has been no definitive research, and there seems to be no real interest from medical professionals. 

The study by Peitzmeier et al was quite an eyeopener. Over half of the respondents to the survey stated that they bind on a daily basis, for an average of 10 hours a day, and most used a commercially available binder, followed by sports bras. Free text responses to methods of binding included belts, girdles and fabric, as well as plastic wrap (cling film). Over 97% reported at least one side effect of binding, with pain being the most common. Just over 50% reported problems with respiratory symptoms and more than ¾ reported skin issues such as swelling and itching to infection and even scarring.

Here are the reported prevalence of each of the 28 recorded health outcomes :

Source: Peitzmeier S, Gardner I, Weinand J, Corbet A, Acevedo K. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Cult Health Sex. 2017 Jan;19(1):64-75.

 If any other intervention, for any other mental health or physical issue, had such high rates of side effects, other treatments would be urgently sought.

The effects of breast binding before the heart, lungs, spine and ribcage have had time to mature is just not known. There has been no definitive research, and there seems to be no real interest from medical professionals.

One of the negative consequences of binding, which is scarcely mentioned, is its effect on the success of surgery. In a study published in the journal Plastic and Reconstructive Surgery in 2008, the authors described the increased laxity and excess of skin caused by long term binding as hindrances to achieving a good outcome from a double mastectomy, euphemistically known as ‘chest wall contouring’ surgery.

There does seem to be one group who are quick to point out the potential harms of binding – the surgeons. Is this altruism on the part of the surgeon? Is he worried about the health effects on his female patients?  Or are these private surgical providers using young women’s discomfort in their own bodies and the extreme side effects resulting from years of breast binding, to motivate them to make permanent changes to their bodies? Changes which will result in never having to bind again – a double mastectomy.

Increasingly,  young girls who are binding are avoiding any physical exertion, and this is the experience of many of our parents. Girls who were previously engaged in sports and physically demanding activities are choosing to give up these interests as wearing a binder restricts their ability to take part. In 2017, The Times reported on the Scout Association policy which instructed leaders to respect trans-identified girls use of binders, rather than encouraging them to wear clothing which would allow them freedom of movement, potentially putting them at risk. Even some local education authorities were instructing schools to allow trans-identified girls extra PE breaks due to their use of breast binders.

How is binding promoted online?

Binder use is mentioned on nearly every trans affirmative charity and organisation website. Thankfully, most of them do carry warnings about potential negative side effects of their use, and almost all of them give tips on ‘how to bind safely’. However, with the complete dearth of research into their use, the advice is not validated by any studies and much of it comes from comments of binder users themselves. The Pietzmeier study only shows that more frequent and longer binding sessions were associated with an increased risk for negative outcomes. 

The warning message found on the GenderKit website

Gendered Intelligence has a page on binding, but only warns readers not to use ACE bandages or duct tape as they can lead to breathing difficulties and injury. The rest of the page links to retailers of binders and how to keep cool – including advice to wear a hat and sunscreen. Quite how UV protection improves the safety of binding is a mystery. 

GIRES, the Gender Identity Research and Education Society [our emphasis] has only 3 links when searching for binders: one which mentions that transmen may be restricted in their movement in sport due to binding; one link to the statement by LGBT Foundation in response to the provision of binders to minors; and one link to the outdated 2008 GIRES Guidance for Clinicians which states “binders can be worn for a short while, but they may cause back problems and possibly also distort breast tissue”. And that’s it. 

The trans charity Mermaids has stated that it does not “endorse or make any recommendation” with regard to binding, but it certainly does not actively discourage children from using them. In fact, searching their website brings up no more than a definition of binding, and a couple of links to external binder retailers. 

A search of Stonewall’s website, brings up no relevant results at all.

Many high profile media outlets have run stories on binding. Here are just a few:

Chest Binding Helps Smooth the Way for Transgender Teens (New Your Times)

Chest Binding and How to Do It Safely (Flare)

Chest Binding is an Integral Part of the Transitioning Process (Pink News)

‘It’s Binding or Suicide’: Transgender and Non-Binary Readers Share Their Experiences With Chest Binders (New York Times)

Here’s the Truth about Chest Binding (Seventeen magazine)

Despite all these articles highlighting the side effects of binding, they still promote the idea that it is beneficial to mental health and wellbeing of those who choose to do it. There are also hundreds of YouTube videos on how to bind – the best methods, the best brands, how to measure, and also many on binding safely. But there doesn’t seem to be a single one on how else women and girls can reduce their discomfort over their breasts.

My daughter has asked for a binder. What shall I do?

Only you and your daughter can decide if the risks of binding are worth it. Some parents decide it is one battle they don’t want to fight, and will help their child measure properly for a binder to ensure the fit is not overly tight. Others will decline the request, and may point their daughter in the direction of sports bras instead. It can be a tricky conversation, but we have a few pointers for you, however you decide to approach the topic.

Listen, Listen, Listen

As with all conversations with your child over aspects of their identity which are acutely personal, listen to what she has to say without judgment. It can be difficult for any daughter to talk to her parents about aspects of her body she’d rather forget about. But gentle questioning about how she feels and why can give you an insight into her world, and help her to see that you are trying to understand her distress.

Explain the side effects

Even those who extol the virtues of binders acknowledge they come with significant side effects. Websites such as Heathline, Pride in Practice and Clue highlight the detrimental effects of binders on health. Openly discuss these with your child, and express your concern for her long term physical health.

Express empathy

Whether she has described her discomfort to you or not, acknowledge that this is how she feels about her body. Explain that developing breasts can be an emotional and uncomfortable time for any young woman, and that she may feel particularly unhappy about them. Alice Hope describes the exact words she used, when her own daughter asked for a binder:

“I see you’re having discomfort around your breasts and I can’t agree to a binder for health reasons. But I would like to do whatever I can to help support you, because I love you and don’t want to see you in distress.”

Suggest a sports or compression bra

Apart from not using binding methods at all, a good, well fitting sports bra could be a healthier alternative to the restrictive fabrics of commercially available binders. Many retail outlets sell a range of extra support sports bras, and having your daughter professionally measured can help ensure the best, most comfortable fit, although this may cause elevated levels of anxiety, so don’t push too hard.

If all else fails, get the fit right

If you have talked through the health risks and she remains insistent on getting a binder, and has the funds and means to purchase one herself, you may wish to help her measure to ensure she buys the correct size and doesn’t purchase one that is too small, in the hopes of achieving a greater flattening effect. Make sure to check out the sizing guide on the retailers website. You may also want to lay down some ground rules about using the binder, based on the community derived guidelines on safe use. These can include:

  • Not wearing the binder for more than 8 hours at a time, and preferably much less
  • Regular breast checks with the GP or practice nurse
  • To take days off from binding
  • To check skin regularly for damage, irritation and infection
  • To not wear it for exercise or to sleep in
  • Removing the binder if in pain
  • That if there are any side effects, that she will alert you to them

Professional Advice

Professor John Benson, Consultant Breast Surgeon, gave this advice to The Times:

Chest-binding should be done under the supervision of a GP or practice nurse. It is important to be aware of how tightly it is being applied, what materials are being used and whether there are quick release catches as duct tape, for example, would be difficult to remove in an emergency.

Binding can affect breathing and can also exacerbate any musculoskeletal condition.

If adults wish to change their body, with the knowledge of the physical risks that entails, that is their choice, but we should think very carefully about guidelines for the under-18s.

Further reading

4th Wave Now – Breast binders and the helpful strangers pushing them on your “son”

Social Transition and Breast Binding

Breast Binding, Sexual Objectification and Grooming

BIND ME: “I’m feeling ecstatic and scared and mum’s feeling sick” – young women binding.


Breast Ironing and Binding: Two sides of the same coin?

“In parts of Africa, pubescent girls undergo ‘breast ironing’ with hot rocks to stop them developing. The practice, condemned as gender-based violence by the UN, leads to breastfeeding problems. Yet here a publicly funded institution [LGBT Foundation] is supporting a practice that may have similar consequences. It is unconscionable.”

Quote from Psychiatrist Dr Lucy Griffin

In 2019, the Criminal Prosecution Service declared the harmful practice of breast ironing – the artificial flattening of a young girl’s breasts by hot irons, pebbles or belts and fabric bindings – a crime, even if the individual concerned has given their consent. A spokesperson  for the CPS  clarified their position on a child being able to give their consent to this:

“Although this abuse often occurs in a family setting, the CPS is clear that a crime is committed when actual harm is caused to a girl – regardless of consent.” 

Those being accused of this practice can be charged with child cruelty or even assault. The CPS guidance states the following:

“…in a family context it may be that the victim consented because of a shared belief in the need to undergo the practice, or because the victim agreed to what the family proposed or the family aided and abetted the flattening. Prosecutors should challenge the raising of consent as a possible defence: it is not possible to consent to an assault where the injury caused is more than transient and trifling. Responsible adults who aid and abet a girl, as the victim, in breast flattening should also be considered for investigation and prosecution.”

This practice is estimated to have been carried out on 1,000 women and girls in the UK. Many of the girls are said to have agreed to the practise,  convinced that this is an effective way to reduce any unsolicited male attention, reduce teen pregnancy and allow girls to complete their education. Breast ironing is one of the worlds most under-reported forms of abuse, and even the National Education Union called for awareness of breast ironing to be made a priority in schools.

But what about those girls who may want to reduce the appearance of their breasts, but who do so whilst exploring a trans identity? The girls who are so ashamed and repulsed by their own developing bodies, that they will resort to duct tape and cling film to bind their chests so tightly they can hardly breathe, and sometimes even break ribs. They deserve protection from harmful practices, too.