Breast binders in high demand in transgender community
Requests for free breast binders by transgender youths in 2022 have outnumbered supplies at Health Care Advocates International (HCAI) in Stratford, which serves LGBTQ and HIV communities. HCAI received 126 binder requests in the first three weeks of January alone, crushing last year’s numbers and temporarily wiping out inventory. The group sent out 190 binders in all of 2021. A quarter of them went to Connecticut youths, with the rest shipped nationwide and beyond.
“The numbers are jumping because there is such a need,” says Tony Ferraiolo, the Youth & Family Program director at HCAI. He began the binder program on his own before working with HCAI because he knew from experience the difference a binder can make in a young person’s life. “When you give a child hope for a better life, they won’t want to take their life. When we give them a binder, they’re walking tall. It is literally life-saving.”
Chest binders compress breasts to give the appearance of a flat chest. For transgender males who were designated female at birth but who identify as male, developed breasts can trigger body dysphoria so debilitating that it can lead to severe depression and worse. “Half of these kids attempt suicide,” Ferraiolo says, citing a finding from a 2018 report by the American Academy of Pediatrics. “Way more than 50 percent do self-harm. One way we can minimize this is to provide them with what they need.”
As soon as Oliver Przech, a 16-year-old junior at Farmington High School and president of the school’s Gender Sexuality Alliance, learned about HCAI’s free binder program in January, he spread the word on Google Classroom. He’d started wearing a binder in secret in the spring of eighth grade, and it helped him survive the school day without paralyzing fear. He wanted to provide that help to others.
“As much as I’d like to, I work a minimum-wage job and can’t afford to buy a binder for everyone who needs one,” Przech said one afternoon during a brief break from his after-school job at the Farmington public library, his one place of refuge during years of internal tumult.
Before Przech learned about binding, he’d spent many months researching, trying to make sense of himself. Finally, he discovered a word that seemed to describe him: transgender. Designated female at birth, Przech knew in his heart, mind and soul that he was male. Breasts, however, advertised otherwise: “This is a female person,” Przech said. “I was really struggling. I had never met anyone else or spoken to anyone else who had felt the way I did.” He suffered from despair so bleak that it landed him in the hospital.
“I knew that wearing a binder was going to make me feel better mentally. I was able to order one on my own and kind of kept it hidden and just wore it to school every day,” Przech said. “Seeing yourself in the mirror and seeing the body that you want looking back at you—seeing something that more reflects how you feel—is very, very beneficial and very helpful just for mental well-being.”
Literally minutes after he posted about the free binders, requests from classmates landed in Ferraiolo’s in-box.
“Oliver is a superhero to me,” Ferraiolo said. “He knows what it meant to be in the darkness. But he also knows what it’s like to put a binder on and be in the light. I know what it’s like to be that transgender kid and not feel like you’re heard. Oliver is providing hope.”
Care under the radar
Christy Olezeski, Ph.D., a child and adolescent psychologist at the Yale School of Medicine whose research and training focused on trauma, found herself working increasingly with clients who questioned their gender. “I was talking to one of my supervisors and asked a very innocent question: Who is providing health care to the trans community, specifically kids and adolescents?”
At best, the answers were anecdotal, so Olezeski set out to learn more. She reached out to Yale endocrinologists, who handle hormone therapy for transgender patients. They enlisted folks from legal and billing, from the medical ethicist and a transgender chaplain. The team slowly but surely created an “under the radar” gender clinic, where patients would see an endocrinologist and a mental health professional during the same visit.
Olezeski and crew offered services for half a day each month in 2018. But demand kept increasing, and the service kept growing. So, last year, the Yale Pediatric Gender Program, which is now official and Olezeski now directs, added clinics in Old Saybrook and Trumbull in addition to New Haven. Patients range in age from 3 to 25. “We have about 400 kids that we’re seeing currently,” Olezeski says. About 57 percent identify as a boy or man, 27 percent as a girl or woman, 13 percent as non-binary and 3 percent as other. The next available appointment for a new patient is in June of 2023. About 220 people are on the waiting list.
For transgender males, puberty can prove paralyzing with its periods and breasts. “They call [breasts] ‘bumps’ or ‘these things.’ It’s really dysphoria-inducing,” Olezeski says. In a restaurant, at school, in family gatherings, out on the street, enlarged breasts identify a person as female. But inside, the person is thinking, “But this is not who I am!” Olezeski says. “A lot of times, there is a really strong discomfort, potentially this repulsion, with this part of the area. Many people cannot feel like they’re in their body. It’s a physical sensation. They can’t take a shower. They steam up the room so they can’t see. We talk to them about getting a loofah on a stick because they can’t touch that area.”
Binders can help. Constructed out of nylon, cotton, Spandex and other stretchable, breathable materials, the garments, which cost around $35, are designed to compress and disperse breast tissue to help convey a flat-chest appearance. A binder can look like a vest, a sports bra, a tank top, an undershirt. Many of HCAI’s binders are donated in bulk by Underworks in Miami. HCAI pays to ship them to people in need. Binders are worn while swimming, at the gym, in school, to sleep—many young transgender males credit binders with helping them survive the day.
Getting dressed without pain
Although binders aren’t supposed to be worn for more than eight hours each day, wearers sometimes trade their physical wellbeing for their emotional health, even sleeping in them. Folks who don’t have access to binders have been known to fashion their own wrap out of Ace bandages, duct tape, plastic wrap. These issues are concerning to Janine Stoner, an occupational therapist at Middlesex Health in Middletown, which runs the Center for Gender Medicine and Wellness. “Nobody really teaches anybody how to bind,” Stoner says. “I always think of preschoolers who play dress-up — nobody plays dress-up with a binder, so where are you supposed to learn these things? People learn either from a friend or from the internet.”
During Middlesex’s 2019 annual Day of G.I.F.T.S. (Gathering Information for Transgender Services), Stoner discovered that “80 to 90 percent of people who use binders had a negative effect,” ranging from skin irritation to constricted breathing to pain in the shoulders, chest and rib cage. “There was a whole host of discomforts. Everybody had something.” This troubled Stoner, an occupational therapist whose goal is to “make people independent in their daily life needs. It should not be painful to get dressed, to represent who you are in a comfortable way.”
Stoner set out to develop a safe binding program that would limit adverse effects on the thoracic wall, protect lung function and safeguard the wearer’s muscles. She lined up co-workers to volunteer for different protocols, trying everything from Kinesio tape to commercial binders. She turned to studies and research for help but only found a few. So, together with Dr. Todd Bishop, the chief of pulmonary medicine at Middlesex, Stoner launched her own study, Binding Among Transmales: Describing the Pulmonary Implications, which is underway.
“I use an incentive spirometer and have them take a deep breath, and I measure. When they have the binder on, I make sure they have enough room in the axillary region and make sure it’s not digging between the ribs. It’s about being safe but effective,” says Stoner, who has been an occupational therapist for 30 years. “It’s a new, emerging aspect of my job. The transgender community has been marginalized by the medical community. I want to make sure I have everything I need for all people.”
Those are reassuring words for Liam Cohen of Bridgeport, who was designated female at birth but identifies as a “trans, nonbinary guy” and prefers the gender-neutral pronoun “they.” But unfortunately, Cohen, 19, has found little understanding among doctors.
“One of the things that’s very disappointing is how few doctors know about trans issues and trans mentality, the psychology behind being trans and having gender dysphoria and how that relates to health care in their specific area,” says Cohen, a freshman at the University of Connecticut. “As soon as I mentioned that I wanted to talk to my obgyn about binding because I wanted to make sure to bind safely, they didn’t know anything about it . ... One thing that’s really disappointing is how few health care professionals know about different gender identities and how to handle having trans patients.”