It used to be that when a 13-year-old wanted a binder for school, it meant a trip to Staples. For today’s tweens and teens who identify as gender-nonconforming or transgender, shopping for a binder may mean a compression undergarment worn to flatten breasts.
Made of thick spandex and nylon, binders resemble tight undershirts, creating a masculine profile. The American Academy of Pediatrics has estimated that 0.7 percent of 13- to 17-year-olds in the United States, about 150,000, identify as transgender. Dr. John Steever, assistant professor of pediatrics at Mount Sinai Adolescent Health Center in Manhattan, who runs its transgender health program and has evaluated over 500 patients from ages 8 to 23, said that almost 95 percent of the transmasculine teenagers in the program bind.
Binders are not classified as medical devices, but some doctors and parents have concerns about their safety. (Common-sense binding guidelines include: Don’t use Ace bandages or duct tape, don’t bind at night, limit a binder to eight to 10 hours a day, don’t shower in it, don’t wear two, and don’t wear one that is too small.)
Though breast compression has been around hundreds of years — think of corsets — commercial binders, primarily sold online, have been available for about 15 years. Marli Washington, 26, a transgender man and founder of GC2B Transitional Apparel, an online binder company, wrote in an email that the company had had “at least a 200 percent growth” since 2015.
Made of thick spandex and nylon, binders resemble tight undershirts.CreditGC2B
Some transgender teens say they buy binders so that they can “pass” as male or to diminish feelings of discomfort with the body known as body dysphoria. And though wearing binders is temporary, their use can be associated with later medical transition. Dr. Steever said most of his patients who use binders “then tell me the next things they want to do, like testosterone, mastectomy and maybe phalloplasty. Ninety-five percent of the people I’ve evaluated get started on cross-hormones.” (Cross-gender hormone treatment in young people may affect future fertility, but data is limited.)
For transgender or gender-nonconforming teens who cannot afford binders, which start at around $30, there are free binder programs. FTM Essentials runs an application and lottery for those age 24 and under. Point of Pride, a transgender nonprofit based in Eugene, Ore., ships binders free to people of any age who express need and has sent over 4,000 nationally and internationally.
Often, teenagers first learn about binders through YouTube videos hosted by young people. An instructional video called “Chest binding” by a Norwegian teenager named Kovu Kingsrod, who wears as many as three sports bras a day, has more than a million views.
Tami Staas, 51, a schoolteacher who lives in Tempe, Ariz., and is president of the Arizona Trans Youth and Parent Organization, has a 21-year-old son who was assigned female at birth and who started binding at 12. He wore a binder about 12 hours a day for five years. He had trouble in gym class and breathing trouble.
“It was like trying to run a marathon in a tight bustier,” Ms. Staas said. “It was difficult for me to weigh: Am I doing the right thing? Is it causing irreparable damage? It was very difficult to watch him cause himself physical pain in order to be comfortable in his own skin.” At 18, he had a double mastectomy, or top surgery, and now takes testosterone weekly.
A 17-year-old in Phoenix who binds daily and asked to be identified only by the initials J.M. said he started binding at 13. To maximize the compression, he bought a binder one size too small and wore it at night. “My arms and hands would feel numb and tingly off and on,” he emailed, “from how tight the material was around that area.” When he removed the binder, he found his skin “severely chafed and raw.”
He added: “The divots left behind from those times took months to heal. In all honesty, I couldn’t have cared less about the damage being created, just that my chest was flat.”
Dr. Ilana Sherer, a pediatrician and founder of the Child and Adolescent Gender Center at the University of California, San Francisco, Benioff Children’s Hospital, emailed that “binders can be physically very uncomfortable and can cause problems especially if overused or ill-fitting, so it’s important that every youth weigh the risks and benefits for themselves and have access to quality, well-fitting binders.”
But even those are correlated with negative health effects. Though there have been no studies on binding and adolescent health, because of ethical concerns about research on minors, a 2017 study by students at the Johns Hopkins Bloomberg School of Public Health, the Boston University School of Medicine, and the Boston University School of Public Health looked at 1,800 transmasculine adults with a median age of 23. Seventy-eight percent of respondents said they had bound for over a year, over half bound an average of seven days a week, and 66.6 percent were interested in top surgery. An additional 13.1 percent had already had the surgery.
Participants reported a statistically significant improvement in mood after binding. They also reported decreased gender dysphoria, anxiety and depression. As for physical effects, 97.2 percent of the group that bound reported at least one negative physical symptom, such as back pain, overheating, chest pain and shortness of breath. Other symptoms included numbness, bad posture and lightheadedness.
Commercial binders were highly associated with negative outcomes (20 of 28 negative outcomes), as were elastic bandages (14 of 28), and duct tape or plastic wrap (13 of 28). One reason may be that commercial binders lend a false sense of security, leading wearers to keep them on too long or sleep in them.
The American Academy of Pediatrics does not have an official position on binding. But in a policy statement last year on care of transgender and gender-diverse children and adolescents, it advocated a “gender-affirmative care model,” where providers convey that “variations in gender identity and expression are normal aspects of human diversity.”
[Read more about caring for transgender children. | Read more about raising a transgender child.]
But some worry that parental efforts to affirm a young person’s identity by supporting binding may contribute to self-hate. Jane Wheeler, a co-founder of an organization called Rethink Identity Medicine Ethics, which examines standards of care for gender-variant children and youth, said binding “feeds into a normalization of body hatred, that some forms of body hatred are O.K.”
Brie Jontry is the spokeswoman for 4thWaveNow, which describes itself as “a community of parents and others concerned about the medicalization of gender atypical youth.” Her daughter, now 15, told Ms. Jontry that she was trans at 11 and wanted a binder. Ms. Jontry bought her a running bra, but her daughter felt it was not constricting enough, refusing to leave the house until she got a binder.
The first one she tried, at age 12, was too tight, Ms. Jontry thought, so they returned it and ordered a larger one. Her daughter, who was home-schooled, bound at home and every time she went out. She stopped running, rock-climbing, backpacking and swimming.
“We would go for our evening walk and she would get winded and dizzy,” Ms. Jontry said. “She stopped climbing trees. She stopped doing things where any degree of upper-body flexibility was important.”
“Binding is not benign,” Ms. Jontry said. “It encourages the idea that people’s distress and anger and trauma should be turned inward toward their own bodies instead of outward toward the culture that feels oppressive to them.”
Dr. Sherer wrote in an email that “it’s strange to me that someone would think of a binder as being a form of self-harm when there are so many other garments used by gender-typical people to change their appearance that are also extremely uncomfortable (hello high heels …).”
But binder use in teenagers may become a thing of the past. Ms. Staas, the Arizona teacher, said that several members of her group take hormone blockers to prevent developing female sex characteristics.
Those youths, she wrote in an email, “will not develop breast tissue and therefore will not have a need to bind their chests.”