Something cropped up in my clinical practice this week that I didn’t know much about, so I did some reading. I thought I would share some info that may be helpful to other HCPs

Chest binding and respiratory function (thread)

Disclaimer: I am not trans, I have no personal experience of binding. I’m nerdy about lungs, inclusivity and healthcare inequality but that’s as far as my expertise goes. I’m always super open to hearing others’ viewpoints and feedback

I don't want to speak for anyone, but I also think its important that the weight of info sharing and education is not always on those from minority groups

Chest binding is compression of the chest tissue used by some transmasculine and gender non conforming people. Some may use it to help them ‘pass’ in society, or to combat intense feelings of discomfort in their body, known as dysphoria

Studies have found binding can improve mood and self esteem and reduce anxiety and depression – the positive effects shouldn’t be underestimated or dismissed

It’s important to note that everyone binds differently – different occasions, times, durations and methods

A good history is essential, but be mindful that these can be sensitive areas to explore. Be open, compassionate and let people put things in their own words. Don’t make any assumptions about what binding means for them

Unfortunately, as well as obviously being uncomfortable, binding can have a significant health impact. In a large study, 97.2% of people reported at least one of 28 negative health side effects associated with binding commonly pain & SOB, but also rib #, ptx & infections

Another study suggested that about 50% of those who bind report some form of associated respiratory symptom
(This is obviously alongside a whole host of non-respiratory issues I won’t go into here)

Unsurprisingly, research is limited, but one small single population study suggested that binding results in abnormal baseline lung function, with a reduction in FVC and expiratory flow

Potential implications of this include increased risk of infections, reduced physical activity due to breathlessness and MSK pain, alterations in breathing pattern, loss of lung volumes, and worsening of any underlying respiratory condition

It’s important to ensure we can understand and explain these risks, both physiological and psychological, in order to support those in our care to make informed and empowered decisions about what’s best for them, and to educate them on the safest ways to approach binding

Do
-Research how to find the right binder
-Follow measuring instructions, and if in doubt, size up
-Regularly wash and air dry binders
-Ensure skin is clean and dry before wearing
-Have days off if possible

Don’t
-Bind for more than 8-12 hours, or sleep in a binder
-Bind with duct tape, bandages, clingfilm etc
-Don’t wear a binder that’s too small or double up
-Bind if you are unwell with any acute respiratory symptoms or flares of an underlying condition

Trans people may be reluctant to seek care for these issues and may not raise the issue of binding. Research has shown that care seeking was associated with feeling safe and comfortable initiating a conversation about binding with a HCP.

It’s on us to create that space where someone feels comfortable discussing these issues. Many will have had negative experiences with HCPs in the past, so take the time to think about how you can build openness and trust with patients who may be particularly anxious or vulnerable

If you don’t know, read up or ask someone!

Some helpful resources:
https://helloclue.com/articles/cycle-a-z/chest-binding-tips-and-tricks-for-trans-men-nonbinary-and-genderfluid
https://www.teni.ie/lifehacks/ 
https://www.nhs.uk/livewell/transhealth/documents/livingmylife.pdf
http://www.gires.org.uk