An LGBTQ+ care specialist talks risks, recommendations and more
If you’re transgender, non-binary or genderfluid, you may be thinking about binding your chest, a practice used to flatten and minimize the appearance of the breasts. But chest binding comes with certain risks, so it’s important to take care to protect your body.
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Transgender health specialist Henry Ng, MD, shares safer chest binding practices that will allow you to live as yourself while taking care of your health.
“Chest binding is using something to flatten the breast tissue of the chest,” Dr. Ng explains. “People who are experiencing gender dysphoria around this part of their body may find it helpful to minimize the presence of those organs.”
Gender dysphoria refers to the incongruence between assigned sex and expressed gender. This discomfort, or dysphoria, stems from the mismatch between a person’s natal gender (the gender they were assigned at birth, typically based on sex organs) and the gender with which they identify (known as gender identity).
“We frequently hear about chest binding amongst people who have targeted dysphoria around their breast organs,” Dr. Ng says. “These organs remind them of their sex assigned at birth, which doesn’t jive with who they really are.”
A chest binder is anything used to bind and flatten the breast tissue to minimize its outward appearance. “There are commercially made products and binders available for purchase,” Dr. Ng says, “and there are also more DIY versions to choose from.”
In addition to commercial binders, which are specially designed to bind the chest, common chest binding methods include:
Some people also turn to homemade options such as elastic bandages, duct tape or plastic wrap, which are widely considered unsafe. (More on that in a moment.)
Unfortunately, Dr. Ng says, there’s currently little data for doctors to draw from when it comes to the overall safety of chest binding. “The data is small. There has simply not been a whole lot published in scientific or medical literature about the experiences and outcomes of binding.”
He points to a 2018 study that identified the possible negative effects of chest binding.
The most common side effects of chest binding are related to skin and breast tissue:
“Keeping a tight, binding material over the chest — especially nonporous materials, like duct tape or plastic wrap — can capture moisture,” Dr. Ng explains. “That can cause skin breakdown and infections, including cellulitis.”
Pain in your chest, shoulders, back and/or abdomen is the second most common category of side effects.
“Your breasts are full of nerves, so it’s not uncommon for people who use chest binders to experience pain from squeezing them down,” Dr. Ng says.
Shortness of breath is another common side effect, especially among people who are overweight or have large breasts. Less common respiratory issues include cough and respiratory infections.
“Having a restrictive device around you makes it harder to breathe,” Dr. Ng says. “People who have asthma or breathing problems shouldn’t bind during an acute illness and should instead wear different types of clothing — hopefully, ones that still let them be who they are.”
Very tight or frequent chest compression can result in severe side effects:
Though less common than other side effects, neurological effects may include:
Additional side effects may include:
“There’s a serious potential to overheat while wearing these types of devices,” Dr. Ng warns. “Nearly everyone I’ve worked with has talked about how they can feel warm to the point of overheating while wearing chest binders on summer days.”
The 2018 study found that 88.9% of respondents experienced at least one negative side effect related to the practice, and nearly 15% sought care related to binding.
Another surprising find: “The study also found that compression methods impacted symptoms,” Dr. Ng says. “Commercial binders were associated with a greater range of symptoms than duct tape or plastic wrap.”
With that in mind, and so little other research available, Dr. Ng says there’s no data that says conclusively whether it’s better to use commercial binders over other methods.
“We should look at commercial binders as a potential tool but approach them like other health and wellness products that aren’t fully tested — like, for example, vitamins and supplements, which aren’t regulated,” he says. “Binders might do the job and provide a desirable outcome, but they’re currently not regulated, so we just don’t know yet whether they cause long-term problems.”
Even without concrete medical data, Dr. Ng says there are some general guidelines to follow for safe chest binding.
Commercial binders can be expensive and may still cause side effects, but they’re made of lightweight materials designed to help your skin breathe, and they’re available in a variety of sizes designed to fit your body well. Sports bras, too, provide some breathability.
Materials such as duct tape and plastic wrap aren’t breathable, resulting in moisture that can cause skin breakdown and even infection. And you risk injuring your skin when removing them.
Because there’s a possibility of overheating while binding, it’s important to stay hydrated while wearing your binder. “Also try not to get overheated or too sweaty while wearing your binder,” Dr. Ng advises.
“When it comes to safer binding practices, the biggest factor is judicious use of binders,” Dr. Ng says. “We do not recommend continuous binding.”
Ideally, identify at least one day a week to go binder-free — and if you experience gender dysphoria without a binder, try to choose times when you’ll be alone or able to wear comfortable clothing that covers your chest.
Always remove your binder when you head to bed, especially if you suffer from sleep apnea or other breathing problems.
“Having something that constricts you at night makes it even more difficult to get sufficient oxygen in your body,” Dr. Ng says.
Armed with knowledge of the possible risks of chest binding, you can be on the lookout for any impact on your own body when you bind.
“Listen to your body, especially if you’re having trouble breathing,” Dr. Ng says. “Pay attention to any irritation, like redness, skin breakdown, bleeding, cracking and pain, which are signs to take a break or to try a different binder.”
There’s no one-size-fits-all method for safe binding, so Dr. Ng suggests speaking with your healthcare provider. They should be able to help you make informed decisions about chest binding based on your individual needs and your unique body.
“A number of factors may influence the recommendation to use a chest binder, including how often to use it and how long to use it,” he says. “If you have chest problems or issues with the heart, lungs or rib cage, or if you’re a person of size, those can all impact your doctor’s recommendations.”
Many transgender folks never undergo gender affirmation surgeries. But in talking to your care provider about chest binding, you may discover that masculinizing chest surgery (sometimes called “top surgery”) is an avenue you’d like to explore.
“Speaking with your healthcare provider is an opportunity to explore other options and opportunities,” Dr. Ng says. “Oftentimes, when patients come in to talk about their discomfort or problems with binding, that information ends up being part of our medical rationale for why a particular surgery is medically necessary, as well as life-saving, for that individual.”
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