What are the guidelines for using BIND in a healthy adult?

Chest Binding in Healthy Adults: Evidence-Based Guidelines

Primary Recommendation

Chest binding should not be discouraged in transgender and gender-diverse individuals, but rather clinicians should provide harm-reduction counseling to minimize physical risks while acknowledging the significant mental health benefits. 1

Understanding the Risk-Benefit Profile

Mental Health Benefits (Priority Outcome)

• Chest binding reduces anxiety, dysphoria-related depression, and suicidality in transmasculine persons 1
• Improves overall emotional well-being and confidence, allowing individuals to function more effectively in daily life 1
• These mental health benefits represent critical quality-of-life and mortality outcomes that must be weighed against physical risks 1

Physical Adverse Effects

• More than 97% of transmasculine persons who bind report adverse physical outcomes 1
• Most common complications include back pain, chest pain, shoulder pain, and dermatologic conditions (skin irritation, infections, acne) 1
• These are generally non-life-threatening but can significantly impact comfort and function 1

Harm-Reduction Counseling Strategy

When providing care to individuals who bind, use the following specific recommendations rather than advising against binding: 1

Timing and Duration

• Bind only when leaving home or in public settings where gender affirmation is most needed 1
• Schedule "off-days" from binding whenever possible to allow tissue recovery 1
• Limit consecutive hours of binding (though specific time limits are not established in current literature) 1

Safe Binding Methods

• Avoid elastic bandages (ACE wraps), duct tape, and plastic wrap as these methods cause the most severe complications including rib fractures, respiratory compromise, and severe skin damage 1
• Use compression shirts or garments specifically designed for chest binding 1
• Ensure proper sizing—garments that are too small increase risk of musculoskeletal and respiratory complications 1

Skin Care

• Practice adequate skin hygiene with daily washing and complete drying before reapplying binders 1
• Monitor for signs of skin breakdown, infection, or persistent irritation 1
• Remove binder immediately if severe pain, breathing difficulty, or skin breakdown occurs 1

Clinical Approach Using Trauma-Informed Care

Communication Framework

• Use open, nonjudgmental language when discussing binding practices 1
• Explicitly ask permission before physical examination of the chest area 1
• Avoid approaching chest examination from behind, which can trigger feelings of being attacked 1
• Consider guided contact where the patient directs the clinician's hand placement during examination 1

Examination Considerations

• Recommend using a chaperone during sensitive examinations, asking the patient's preference for chaperone gender to provide empowerment and choice 1
• Delay sensitive examinations until trust is established unless medically urgent 1
• Maintain patient autonomy and control throughout the clinical encounter 1

Critical Clinical Pitfall to Avoid

Do NOT recommend against binding entirely, as this approach ignores the substantial mental health benefits and may damage the therapeutic relationship, leading to loss of follow-up and inability to provide harm-reduction guidance. 1 Instead, acknowledge both the benefits and risks, then focus counseling on risk minimization strategies that allow the patient to make informed decisions contributing to both physical and mental health. 1

Monitoring and Follow-Up

• Assess for musculoskeletal pain (back, chest, shoulders) at each visit 1
• Examine skin for dermatologic complications when appropriate 1
• Reassess mental health outcomes including anxiety and depression 1
• Provide ongoing education as new evidence emerges on safer binding practices 1