Binding and Tucking: Self Harm 101

Written by a Genspect parent and health professional

Part I: Binding

Many parents of kids who are on the trans pathway (the majority of whom are girls) will be familiar with breast binding. For those who are not, this article by the UK’s Bayswater Support provides a good explanation of the practice. In summary, it involves females tightly binding the chest to hide their breasts and achieve a more “masculine” appearance.

A large survey involving 1800 participants showed multiple adverse effects from binding. Although the full study is behind a paywall,  the results are summarized in the Bayswater article cited above. Fully 97% experienced one or more side effects. These included pain, shortness of breath, digestive issues, and neurological issues. A total of 28 different side effects were reported, and it is evident when looking at the figures that many subjects must have experienced multiple issues. Still, the author of the study, Sarah Peitzmeier, felt it appropriate to comment: “For those with intense dysphoria, we saw that binding might dramatically reduce suicidality, anxiety, depression, and dysphoria. It could be literally lifesaving for them.”

This was in spite of the fact that the study did not collect the data needed to draw any such conclusion. As the Bayswater article points out: “The single question they asked about mental health did not specifically investigate suicidality, anxiety, or depression, used no validated psychological measures of these symptoms, but simply asked respondents to rate their overall ‘mood’ on a scale of 1 to 5, very negative to very positive. They compared the ratings before and after binding and they did find a statistically significant increase in self-reported mood after binding, from an average rating of 2.1 before to 3.8 after. But the word ‘mood’ can be widely interpreted, and is certainly not an objective measure of suicidality.”

The Bayswater article also makes clear the role of the media in promoting this harmful practice. It lists numerous articles, including one from a prominent American publication entitled It’s Binding or Suicide, which breaches basic journalistic ethical guidelines around the reporting of suicidality. This article simplifies a complex subject by suggesting that a single factor can trigger suicide and fails to emphasize that suicide is preventable. It says nothing about the possibility of accessing non-medical-device methods to deal with bodily distress, such as psychotherapy. It also explicitly (and falsely) indicates that a self-harm practice may be necessary to prevent suicide, in both the title and quotes from interviewees, such as this: “Binding is not fun, and it’s not a trend. We are well aware of the risks, but for many transmasculine people, it’s binding or suicide.”

Reading some of the testimonials in the article is heart rending: “I have been binding for four years, starting at age 16…. The longer I used binding, the more I could feel my body deteriorating. The physical pain got worse but so did the emotional. Slowly I began living a life where I couldn’t not bind. The initial euphoria of flatness turned into never being able to get flat enough. My body aches every day, I no longer have the lung capacity I once had, and my ribs have inverted. I fear breaking one when I sneeze.”

However, rather that ceasing this self harm and accessing healthier ways of managing distress, the solution presented is for this young woman to have her breasts removed: “I am getting surgery this year and it can’t come soon enough.”

In another particularly egregious example of irresponsible reporting, The Australian Broadcasting Corporation (Australia’s national broadcaster), which is legally mandated to provide balanced reporting, published a glowing report about a project to improve access to binders for young women living in the brutal tropical climate of Cairns. It falsely states that binders are “safe” and that they “allow for a full range of breathing” – both assertions clearly contradicted by the Peitzmeier study. It makes no mention at all of adverse effects.

Celebrities too have jumped on the bandwagon. Actress Emma Corrin was lauded by media for posting “arresting” photos of “themself” wearing a makeshift breast binder on social media.

Part II: Tucking

It is important to spread awareness of a male version of this practice – genital tucking. Tucking involves compressing male genitals into the groin or up between the legs to produce a flat “feminine” appearance – in some cases actually pushing the testicles up the inguinal canals into the body, as shown in the diagram from this wikihow guide to the practice. Everything is then secured in place with tape, tight underwear, or a “gaff.”

To understand the potential harms of tucking, a brief anatomy lesson is needed. Have you ever wondered why the delicate, sensitive testicles hang outside the body in the scrotum? It all has to do with temperature. To maintain their health and serve one of their primary functions – to produce healthy sperm (the other is to produce the male hormone testosterone) – the testicles must be maintained  at a lower body temperature than is available inside the body. In a perfect example of the elegant function of the human body, the scrotum will automatically draw the testicles up or lower them down as needed according to the ambient temperature to maintain perfect conditions for health and sperm production.

There is a paucity of research about the potential harms of genital tucking. However, given the testicles’ temperature requirements, tucking them against (or even inside) the body for long periods could certainly be expected to be harmful to their health and function.

The condition of undescended testicles occurs when  the testicles fail to descend into the scrotum as they should before or shortly after birth,  but remain in the inguinal canals or abdomen. This is well recognized to lead to an increased risk of infertility, torsion (twisting) of the testicle (which is a surgical emergency and may lead to the testicle needing to be removed), and testicular cancer.

Tucking could well lead to these same side effects, as the testicles are being placed in the same position they inhabit when undescended. There are case studies of both infertility and testicular torsion occurring from tucking.

With regard to sterility, materials written by activists may deny that tucking produces sterility but produce no evidence to back up this claim, while simultaneously acknowledging there is little research on the topic. Other materials promoting tucking acknowledge the likelihood of effects on fertility, as well as other side effects, while continuing to promote the practice.

Regarding testicular cancer, I am not aware of any research which investigates whether tucking increases the risk. Of interest, surgeons tell us that some males have normally descended testicles when younger, only for them to re-ascend as they grow. The author of this piece notes: “We do not know if testes that were once in the scrotum and then ascend over time have an increased risk of cancer or not.”

However, in the study referred to in the article, the authors recommended  orchidectomy (removal of the testicle) in cases of undescended testicles diagnosed in adulthood,  as there is usually poor sperm production in any case, and the risk of cancer is of concern.

The only study I am aware of on tucking (which also looked at binding) revealed multiple adverse effects including itching, rash, testicular pain, penile pain, and skin infections.

Much more research is needed on the physical effects of tucking, especially with regard to the very serious matter of testicular cancer. But in a climate where research on any topic that does not promote the approved narrative is actively discouraged, it seems unlikely that this will occur.

Part III: Psychological harms

Then there are the likely psychological harms. Both tucking and binding involve teens inflicting discomfort, pain, and in some cases permanent harm to themselves in an attempt to hide the most visible signs of their developing adult sexuality from the world and from themselves. Hence normal adolescent discomfort with pubertal development is transformed into shame, bodily dissociation, and self harm. Is it any wonder that social transition (adopting a new name and the pronouns, dress, and hairstyle of the opposite sex), which often involves tucking or binding, is known to increase the chance of young people going on to medical transition down the road? 

The possible connection of binding to the increasing sexualization of girls in our culture must also be considered. The UK campaign group Transgender Trend has produced a thought-provoking piece reflecting on this issue. They also reveal that the country’s National Health Service, as well as schools throughout the UK,  are promoting the practice.

Of course there is money to be made from our kids here too. When you can sell what is basically an undersized pair of underwear for AU$40 (US$28) for the basic version or AU$53 (US$37) for the luxury version, there are serious profits to be pocketed.

Looking for something even better? For the Rolls Royce option, one can purchase a “tuck kit” for US$89.95 for a thirty-day supply – more than $1000 per year – posted in discreet packaging so parents will not know what the young person is up to.

On the other hand, if a  person is suffering from financial challenges (which might apply to a young teen who has no source of income and wishes to hide the fact that he is tucking from parents), he can request a free gaff to be posted to his home. The minimum age for this service to be provided without parental consent is just 14.  

For girls who wish to obtain a free binder without parental knowledge, a UK charity will oblige her as young as age 13 (and who knows, perhaps even younger).

Breast binders are also widely available purchase online; Amazon sells dozens of different kinds. For the person who has everything, you can even buy a “binder pin” to show the world how proud you are to be binding your breasts and to help raise funds to provide “life-affirming binders for those in need.”

Our young people are influenced by activists, government-funded organizations, and gender clinics that believe binding and tucking are ‘affirming,” that is, that they enhance mental health and well being.

I beg to differ. Smoking pot, drinking alcohol to excess, or shooting up heroin feels pretty good too – for now.  So does starving (for anorexics), bingeing and purging (for bulimics),  and cutting (for troubled youth with various mental health problems).

The devastating long-term effects of these practices, however, lead the adults in the room  to understand that they should be discouraged and that the troubled young people who engage in them need to be lovingly provided with the care they need and taught healthy strategies to manage their distress, such as therapy, mindfulness, exercise, and psychotropic medication (where needed). There is no shortage of well-tested options.

As a parent and a health professional, I call upon society in general, and health professionals in particular, to stop the untested and unproven cruelty of both binding and tucking, to stop promoting self harm and bodily dissociation in our vulnerable young people, and to instead assist them to find healthier ways to manage their distress.

Image credit: Genusfotografen (genusfotografen.se) & Wikimedia Sverige (wikimedia.se), CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons

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