• Chelsea Unruh, MD

Binding and Breath

Breathing. It’s something we often take for granted and don’t think much about. Besides keeping you alive, breathing can help you slow down, manage anxiety, focus your attention, and even reduce pain. It’s kind of our body’s built-in wonder drug!. Breathing is the foundation of things like meditation and biofeedback. Yet, for those of us living with certain forms of gender and body dysphoria, easy breathing can be a challenge….and well, not so easy after all. I’m talking about binding. 

Chest binding is a way to flatten one’s given chest to give a more masculine appearance and to reduce the appearance  of given chest/breast tissue. For many transmen and masc-of-center nonbinary folx, a binder is a self-required item to have on before leaving the house. Binders help us feel better in our bodies, help prevent misgendering, and give confidence to appear in our identified gender. 

They also can restrict breathing. In our current COVID-19 pandemic, that is problematic. 

The CDC is recommending the use of cloth face coverings to help prevent the spread of coronavirus. This is an important tool particularly in public spaces like grocery stores and pharmacies where social distancing measures are difficult to maintain. However, these face coverings can mimic symptoms that binder users report including shortness of breath and overheating. Binder users also commonly report back and chest pain as negative outcomes from use.  These outcomes can be reduced with changing how and which binders we use, according to this study

The article (published in 2017 in the Culture, Health & Sexuality journal) was one of the first population-based studies on binder usage. Researchers surveyed 1,800 AFAB transgender and intersex binder users over the age of 18 from 38 countries and analyzed the data. They found that the average days per week spent binding correlated the most to the self reported negative outcomes. It’s suggested that taking days off from binding may reduce the risk of these health impacts.

The use of commercial binders is another factor most consistently found to correlate with negative health outcomes. This is likely due to the significant compression these binders provide.  It is  surprising that the binders most of us have come to think of as the safest are actually causing the most harm. Of course, elastic bandages, plastic wrap and duct tape were also commonly associated with negative outcomes, as we’d expect. 

So what does all this mean in the context of our “new normal”?  Ultimately, we must weigh the risks and benefits of the items we use to protect ourselves and others from disease with the items we use to decrease our dysphoria. As a genderqueer physician, I highly support wearing cloth face coverings or masks anytime you leave your home or with any interaction with others who do not live with you. Infection control in these times is key.

As for binding, if you are home and can tolerate it, skip the commercial binder and take a deep breath. If you do need to leave your home, consider short term use of sports bras, layering sports bras or other  athletic compression wear instead of the commercial binder. These alternative items  usually allow for easier breathing. We all work within the context of our own mental and physical health and we need to do what we feel is safest for our bodies. While you consider your options and is right for you, I ask that you also consider the social responsibility we each carry to protect ourselves and others during these times. And remember, breathe. For help with that, here a link for 6 deep breathing apps

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