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Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study

Authors:

Abstract

Chest binding involves the compression of chest tissue for masculine gender expression among people assigned a female sex at birth, particularly transgender and gender non-conforming individuals. There are no peer-reviewed studies that directly assess the health impacts of chest binding, yet transgender community resources commonly discuss symptoms such as pain and scarring. A cross-sectional 32-item survey was administered online to an anonymous, non-random sample of adults who were assigned a female sex at birth and had had experience of binding (n = 1800). Multivariate regression models were used to identify practices associated with self-reported health outcomes. Of participants, 51.5% reported daily binding. Over 97% reported at least one of 28 negative outcomes attributed to binding. Frequency (days/week) was consistently associated with negative outcomes (22/28 outcomes). Compression methods associated with symptoms were commercial binders (20/28), elastic bandages (14/28) and duct tape or plastic wrap (13/28). Larger chest size was primarily associated with dermatological problems. Binding is a frequent activity for many transmasculine individuals, despite associated symptoms. Study findings offer evidence of how binding practices may enhance or reduce risk. Clinicians caring for transmasculine patients should assess binding practices and help patients manage risk.
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Health impact of chest binding among transgender adults: A
community-engaged, cross-sectional study


aJohn Hopkins School of Public Health, Baltimore, USA; Boston University
School of Medicine, Boston, USA; cBoston University School of Public Health
 !"#$%&"!
'()*)!!
Culture, Health & Sexuality"
+!!,-./,0"
http://www.tandfonline.com/doi/full/10.1080/13691058.2016.1191675
'1!
! CHS"
2
Abstract
 )!)! 
  )!
  2) !"'2
1!) 
 !!!!
 "23.2!1
!2)!11 )
) 45,6//7"8! 
1!)1)2
!"9)) "+:;<
).6 !! "=>!
4?1@711 !4..).67"
11
4./?.67 4,-?.67!14,3?.67"
A 11@"B 
)>!)!!
"!C D)1 
!@" )!!
  @"
Keywords$ ! AB'
3
Introduction
 )!!!>!)
 !! !!11
 ))!!"'
!1))224='87
  >! 2) 
1@!/"3</"E<)F
)!-;/6:3;6-6..F
4./,,./,.7"+!!>!!!
!! C
)!G)
49!.//-7"'!!
 ) 49!.//-7
1 4""!D1
!H  74B@ .//0
8./,.7?))!4A
.//-#@ .//07"B !
!I!!6;<)! 
4./,E7"=! 
!
C49./,,7"=
!1!! 4J
! H7 !!!! 
4=*!.//67"91!1
! 4=*!.//6
*./,37"
! 2D) 
!!4K!.//67"
D)  
!41)@.//37 49!./,.7!
1!!48@./,-7"
#)! 
) !! 4L
.//:7@?48.//6B./,.7! 
)!!4' !./,-7)4=
 .//0I9!.//-7" !C
@!@!
! !)!1!!!! 
48.//6B./,../,E7"!
!AB'M!
 ) !$1 
 !) !1 
1   62,.!?4M8!
./,3I)F./,-7"' 
4
1 !2
!"
'B 9&4B97!2  
&)! "'
&)1,7!) 
! 1.7)@)) 
!372
) @)"
Methods
!3.22!
) !
! >!)2!)
2C"M!1 ! 
!1!1!
!! !")!2 !
)!1   
!!))!) 
>! I)!
!1"'!! >!)
@)) !1
!! !1) )1@)
 !,7)!  )
>!!).7!  
!H>!))
C !1!)
   37
 !1!)!!
-7! ) 
)!!"
Study population
!!1"!!
=@'1'!)"'&
 AB'M! ! 
12)!  
2) !"!@
!1! @1 1
1@"'!1) 4=B7
2C! ),61!)
!")1
1!!)1
1!"1 @
>!))1 "'!1
5
BF!*1B"'!
1!8./,-")./,.!
1"!)! ),61
45.,.7! C),6//"
Measures
 21!
))AB' !
!1!).6!
1 "!11!! 
!8) 1@1
)"')
!! )4.//,I81
8 .//0I'./,.7)4.//,I
B@ .//0IL.//;7@4'./,.7
 !4 @!74.//,I81
8 .//0IB./,.7 4B@ .//07
 4L.//;I8.//6B
./,.7"!)!
1! !)!!12
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)!"K 1!
!))!) 
!! AB'M!4.//-I8.//-
'!1B.//:71  
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G!!2!! !
 4!9./,-IM8!./,3I)
F./,-7"
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!&J H!1 !
 ) !1@ ! 
))!
 !  1 
@ @)"') 2
!11)2! 
!1 !"!1@J9!
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 OH)!"
6
!)  1"
11.E 
)"=!)!  
1 !!! 
1! !"
')>!) 1@J91
 !OH!)
1@  "') 
1@J91! !OH
!1,.-"' !
1@J91 ! 1 
!!O4""1@7H),,
   )J,31@HJ;PH"  !
) Q 2R)!)
@2) @ 1!
!   )>!! 
 >!!) 6!
);1@"
1@ 
!1>!J47?!!
)&)ON!!H"+!
  !
11!?1
"1))
JH "=1 2 
 JH ! 1!
! !1"' ! 
1 )1@
!1! "
1@)2!!"B9
)! 4""J36KKH7 
!  )4""J#H7"+!!) ! 
1  
!1!G!!4!)
!17"
11
! ) !!4./,-+./,-7"
1  
 !!
12!!"
Statistical analysis
'1./,E"K1!
!  )>!)
!"21! )
7
) "B1!!
1)@).6
!"'12 !  )
).6! 1!))
11!"#
!! 4)>!!
7 4 7"'  
!) 4 271!!
))>!!
)11!"
Results
'&)F406",<74,3"E<7
136!4',7"H  
),6001 ).3"
;/!>! 1!!!"
' !14;:"E<06",<
71!)  >! 
))2C!"'
&! !!! 
460":<7!1 ! 
)!!400"0<7"
'1 11!
D) 1
143),E7")2
D1!1>! 
!)2
C !)!"
)21 I JH
JH);"E<0:":<1 "+ 
S )))  C
).",3"6E24D5,";3:E<
4,"0;,";:77"
T',U
B 1!)1E,"E<
 1@ 4'.7" 
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4;6<7!)"'!)
 11"F!1"
B 1! &! 
46;".<7"433",<7 4.-"/<7
 !4,6"0<7!  
4,0"E<71"
8
T'.U
# ! 1
!1:;".<)  !
! "'!1
@4E3"6<7 4E3"E<74-6"6<7)
4-0"0<7 4--":<7!4-/"3<7!
436":<74'37"+) @?)!
11;0"3<) 
@?!;-"/< 2"
T'3U
+C) 
).6! ,"
 211.-).6!"
11,E).6!"
91)&! )  
!11
@) 1)!!"
!)>!1)
1 !4..).6!74'-7"
K!11,3).6!"A 
11 ),,).6
!"11@)!
!!1 !
1!!@! 
!"1 
1 !4./?.67)1
 4,-?.67!14,3?.67"
T'-U
Discussion
'!C
))2!  
!!")2) 
  
D"'C !  )
!!"
B )>! 1@ 1
)1@))2 
!&!4..?.6!7"'! @ 
JDH) !!@) 
9
"' ))
 !@D"
!!! !  
4""! 7! 
D49!.//-I' !./,-7!!
!1 !1
!!"B!
!! )>!) 
)! ) 
 "
B 11!
11 
1 "91)&! ) 
1!1!!
1) 1)!!
4! ) !1@7"'! C
!)!1!1
 !!  
11 !"
!!!  )
 !!
 !)!!1
  !"
)>!!4!) 
 ))>!71
1!!@)!
!!!@!"*! ! 
) )!@) 
 !!"=!
  C !! 4S
! S7D1@1!)
!>!))4L1C.//0)
)' 9./,.7"=1! 
1V!)C
@
! "
1 
1 !!!
 "
'C 1!
)49./,,IM8!./,3I
)F./,-I9!.//-I' !./,-7"'!@
!V!H )
!)@)!1 !
  @1!"
# !11
10
1 !C 1 
! !" 
11 
1 !)
)) "
A 11)2@
)!!"#@1 
!   @ )
 ! !?)>!) "
!  1 
!1 C
"2>!!
D) V
 ) !1  D"8
 )!!
2!
12 ) !!1C"
Clinical implications and conclusions
BC )!!
1!! 
)1!1
 C"! !
 H 
! ) 
!@C) )"
!! 
1>!))C"
=1 !!&! 
  2@ 1
!"  D)
 !@C!
1!)  )
!!V.
9!
 !1  JD2H)
 1  !
1) ! !1"
!!1C
!)!1!  @ 
@!"
!!) 
 1!))! 
 !)  !
1 >!))4L1C.//07"
11
!!  
!1 !
@    !
D>!))" !)!
1@1!) 
@11!@
)! !)
"
12
References
".//-"'+1$AB'N! 
"L1N@$AK)!)8"
B8""!*"KK"./,."Q=228' 
*!$A ! 2! 
#"RJournal of Plastic, Reconstructive & Aesthetic Surgery
0E407$;,,W:"
B@ "!" "8".//0"Q! 8
9)' !A+"RInternational
Journal of Transgenderism:432-7$3E26."
B"9A"./,,"Q= +!$!9)
A)B1B"R+@$B1B&"
!9"./,-"QBB )"R!F9"
.0./,-"$?? @"!"!?2
 2)
"""1""A""./,."Q' 
98!$*!)9!
)!"RAmerican Journal of Public Health",/.4,7$,,6W,.."
K!A" "=".//6" ))22
 "!)81)9" E34-7
33,W;"
#@*" K".//0"'' "'!+@
"$#"
=*"*!#".//6"Q#  !
  !) !F$
8'=='8 >!"RHealth Sociolology Review.,;437$.3EW
.E3"
=" ".//0Q' $
!  !)B!"RVancouver
Coast Transgender Heal Program"8.../,E"
$??"!)"!?O 52
""./,,"Q918AB!
' OR!"8.../,E"
$??" ?!??/:06-."
9!"./,."Q9 8! $
* 8K"RF!K
F"
9!".//-"Q9!H='8*!!R"8.../,E"
$??111") !" ?
"#".//,"Q' $*!
)!"R$'F
"
13
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8!) 0"04,,67
16
  ,";43,7
 ,"34.-7
+ /"04,/7
'! 4L5,;:07
9!  ,3",4.307
   !  00"04,,:;7
L   
! 
,.":4.3.7
F! ;"34,3,7
91!!
D) !O
4L5,;667
,4L7 ,E"-4.;E7
. .E",4--67
3 .6"04E,.7
- ,6"043337
E4(7 ,."34../7
911!!!
),2E)
 O4L5,;::7
,4( 7 3,",4EE:7
. 36"-40:,7
3 .3"/4-,-7
- E".4:37
E4(7 ."34-.7
8 .",
911!!!
),2E) O
4L5,;::7
,4( 7 ,"34.37
. -"34;67
17
3 .-"E4--,7
- E/"E4:/:7
E4(7 ,:"343-67
8 3"6
18
'.$K!)  
<47I!1
L5,6//
8! 
4M*7
,/!46,.7
81@ 
4M*7
;1@4-;7
8!) 4M*7 .4,-7
B !47
B 6;".4,E;/7
 33",4E:;7
 .-"/4-3.7
8! ,6"0433E7
#  ,0"E4.:67
1 ,E"34.;07
L1 0"04,,67
K!1 -"34;67
9 3",4EE7
4L5,E,E7
 ,.";4,:37
B .-"/430-7
 .3"6430,7
K ,E"/4..;7
# ,0".4.-E7
=  6"34,.E7
19
'3$))2!!
9+!47 <47L5,6//
Pain
 -6"646;67
! 36":4;//7
B@ E3"64:0:7
 ,-"E4.0.7
! ;-"/4,3337
Musculoskeletal
*=! ."64E/7
*  ,,"04./:7
B! -/"34;.07
!&Q R ,."34..,7
8!1 E"-4:;7
!!@! -0"646-37
Neurological
L! ,E";4.6.7
9 ,:",43--7
A  .;"64E//7
! ! -,"/4;367
Gastrointestinal
K ! ,,"34./37
9! ,,",4.//7
 ! ,;";43,67
Generalised
+ E3"E4:037
= ! .;".4-6:7
20
@ ,;"343,,7
 ! 0,";4,,,.7
Respiratory
!  ,;".43,/7
*) 3"-40.7
) -0"0463:7
! E/";4:,-7
Skin/tissue
B  .;"E4-:E7
B 33":40,,7
 ;";4,367
1 -"34;;7
 33"640/67
 --":46/67
@  ,E".4.;37
@) E"34:E7
@?!! ;0"34,3;E7
) :;".4,;E/7
21
'-$!)! ).6)2
!"
4!?7
=>!4?1@7
K!47

B


8!
# 
1
L1
K!1
9

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,"
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."
3   
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)! 1!)
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I  "B@1
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L!L! I**
23
Appendix
',$*!)  )!"B)
 C"
+! ( B+* 8!+*
+!
B@ 4!?7
1.03 (1.01,
1.06)*
,"/,4/":6,"/-7
=>!4?1@7
1.13 (1.08,
1.18)**
1.10 (1.04,
1.17)**
K!47
1.09 (1.04,
1.14)**
,"/,4/":0,"/;7
' 4 2
7
1.07 (1.04,
1.10)**
222222
 /"::4/":-,"/07 /"::4/":3,"/E7
B 
B
1.76 (1.33,
2.33)**
2.18 (1.53,
3.13)**
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1.34 (1.08,
1.67)**
1.40 (1.07,
1.85)*
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8! ,"/:4/"60,"367 ,"/04/";:,"-,7
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 
1.56 (1.21,
2.01)**
1.53 (1.12,
2.10)**
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1
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L
1
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K!
1
2.58 (1.57,
4.44)**
2.78 (1.52,
5.31)**
9 /"6.4/"-6,"-,7 /"0;4/"3E,".:7
! 4!?7
1.05 (1.02,
1.07)** ,"/,4/":6,"/E7
=>!4?1@7 1.20 (1.14, 1.18 (1.11,
24
1.26)** 1.26)**
K!47
1.14 (1.09,
1.19)**
1.06 (1.00,
1.12)*
' 4 2
7
1.09 (1.06,
1.12)** 222222
 ,"/.4/":0,"/67 ,"/.4/":0,"/:7
B 
B
1.80 (1.33,
2.47)**
2.54 (1.73,
3.82)**

1.61 (1.30,
2.01)**
1.54 (1.17,
2.03)**
 ,",/4/":/,"3E7 ,",E4/"6:,"E/7
8!
1.27 (1.00,
1.62)* ,"./4/"6:,"0,7
#
 
1.43 (1.12,
1.83)** ,"3-4/":6,"637

1
1.38 (1.07,
1.79)* ,"/-4/";E,"--7
L
1
1.84 (1.28,
2.66)** ,"334/"60."/07
K!
1
1.99 (1.26,
3.16)**
2.12 (1.20,
3.79)**
9 /"634/"-0,"-37 /"6/4/"3:,"E:7
 4!?7 ,"//4/":;,"/.7 /"::4/":0,"/.7
=>!4?1@7 ,"/.4/":6,"/07 ,"/.4/":0,"/67
K!47
1.07 (1.02,
1.12)** ,"/34/":;,"/67
' 4 2
7 ,"/.4/"::,"/E7 222222
 ,"/-4/":6,",,7 ,"/34/":;,",/7
B 
B ,",64/"6:,"E07
1.56 (1.10,
2.21)*
25

1.38 (1.11,
1.72)** ,".,4/":3,"E:7
 ,",;4/":0,"-.7 ,"/-4/"6,,"337
8!
1.46 (1.15,
1.85)** ,"3,4/"::,";-7
#
 
1.77 (1.38,
2.28)**
1.50 (1.11,
2.03)**

1
1.36 (1.05,
1.76)* ,"/:4/"6/,"-:7
L
1 ,"3;4/":E,"::7 ,",/4/";.,"0:7
K!
1
3.19 (1.94,
5.48)**
2.58 (1.44,
4.87)**
9 ,"0/4/":3."6/7 ,"0/4/"6-3",/7
 4!?7 ,"/,4/":6,"/E7 /"::4/":E,"/-7
=>!4?1@7 ,"/04/"::,",37 ,"/E4/":;,",-7
K!47
1.08 (1.01,
1.14)* ,"/.4/":E,",/7
' 4 2
7
1.04 (1.01,
1.08)* 222222
 ,"/04/":;,",E7 ,"/E4/":0,",-7
B 
B ,"E/4/":6."3:7 ,"-E4/"66."-67
 ,",04/"6E,"EE7 ,"/E4/";.,"E.7
 ,"/.4/";;,"3-7 /":64/"0:,"3:7
8! ,"3.4/":E,"6/7 ,".,4/"6.,";07
#
  ,",64/"6-,"0-7 ,"/:4/";.,"037

1 ,"-/4/"::,":E7 ,"/-4/"0;,"E:7
L
1
1.82 (1.15,
2.80)* ,"0/4/":-."007
K! 1.96 (1.12, 1.99 (1.04,
26
1 3.29)* 3.69)*
9 ,"//4/"-3."/37 /"6/4/".:,"6E7
8!!@!
*)! 4!?7
1.11 (1.04,
1.18)** ,"/.4/":3,",/7
=>!4?1@7
1.58 (1.26,
2.13)**
1.41 (1.11,
1.93)**
K!47
1.28 (1.13,
1.45)** ,",04,"//,"3-7
' 4 2
7
1.15 (1.08,
1.22)** 222222
 ,",04/"::,"3E7 ,"./4,"//,"-.7
B 
B ,"0;4/"0;E"E67 ,"--4/"E.E",37
 ,"E,4/"6/.";.7 ,"364/"0..":.7
 /":34/"-:,"007 /"6,4/"30,";.7
8! ,".34/"0/."3E7 /";:4/"33,";37
#
 
3.41 (1.89,
6.06)**
2.42 (1.17,
4.83)*

1
2.95 (1.59,
5.31)**
2.27 (1.03,
4.81)*
L
1
2.71 (1.16,
5.61)* /":;4/"3-."-07
K!
1
3.18 (1.18,
7.17)* ,"004/"E3-"E67
9 ,"334/".,-"-;7 /"064/"/:.";:7
*
  4!?7
1.07 (1.03,
1.10)** /":64/":3,"/37
=>!4?1@7
1.44 (1.30,
1.61)**
1.44 (1.27,
1.66)**
K!47
1.24 (1.16,
1.32)**
1.15 (1.06,
1.25)**
' 4 2 1.14 (1.10, 222222
27
7 1.18)**
 ,"/-4/":E,",37 ,"/E4/":E,",07
B 
B
3.12 (1.71,
6.40)**
3.31 (1.61,
7.78)**
 ,"304/":6,"607
1.62 (1.06,
2.46)*
 /";E4/"E-,"/37 /";04/"-:,",E7
8! ,",,4/";0,"E;7 ,",04/";3,"6/7
#
 
1.85 (1.31,
2.58)**
1.81 (1.18,
2.74)**

1 ,",;4/";6,"0:7 /";:4/"-;,"3,7
L
1
2.07 (1.28,
3.25)** ,"-64/"6,."0-7
K!
1
2.60 (1.48,
4.37)**
2.12 (1.04,
4.20)*
9 ,";34/"6,3"3-7 ,",-4/"-,."6/7
B! 4!?7
1.08 (1.05,
1.11)** ,"/.4/"::,"/E7
=>!4?1@7
1.23 (1.17,
1.30)**
1.20 (1.13,
1.28)**
K!47
1.23 (1.17,
1.29)**
1.16 (1.10,
1.23)**
' 4 2
7
1.16 (1.12,
1.19)** 222222

1.07 (1.00,
1.13)*
1.08 (1.01,
1.15)*
B 
B
1.48 (1.11,
2.01)**
1.85 (1.27,
2.74)**

1.58 (1.27,
1.97)**
1.54 (1.16,
2.04)**
 ,"/,4/"63,".37 ,",.4/"60,"-07
28
8! ,",;4/":.,"-67 ,",64/"6;,"E:7
#
 
1.74 (1.36,
2.23)**
1.62 (1.18,
2.21)**

1 ,"3,4,"/,,"0:7 /"::4/";,,"367
L
1
1.50 (1.04,
2.16)* /":-4/"0/,"-;7
K!
1
2.33 (1.47,
3.74)** ,"0-4/":..":E7
9 ,"E04/":,."0;7 ,"E:4/"6,3",37
!&
Q R 4!?7
1.06 (1.02,
1.09)** ,"/,4/":0,"/E7
=>!4?1@7
1.22 (1.12,
1.33)**
1.21 (1.09,
1.34)**
K!47
1.14 (1.07,
1.22)** ,"/E4/":;,",37
' 4 2
7
1.08 (1.05,
1.12)** 222222
 ,"/E4/":0,",-7 ,"/04/":0,",07
B 
B
1.60 (1.00,
2.70)*
2.05 (1.15,
3.91)*
 ,"3,4/":E,";67 ,".04/"6-,"6;7
 ,"/04/";:,"-.7 ,".,4/"6.,";07
8! ,"/.4/";,,"-E7 /"6-4/"E3,".:7
#
 
1.70 (1.21,
2.37)**
1.65 (1.09,
2.47)*

1 ,"--4/"::."/-7 ,"/34/"0-,"0.7
L
1
1.72 (1.04,
2.72)* ,"334/";-."3/7
K!
1
1.91 (1.05,
3.29)* ,"0-4/"6,3",;7
9 ,"0.4/";03",37 ,"034/"063"E-7
29
8!1 4!?7
1.11 (1.06,
1.16)** ,"/34/":0,"/:7
=>!4?1@7
1.50 (1.28,
1.82)**
1.31 (1.10,
1.61)**
K!47
1.31 (1.20,
1.44)**
1.26 (1.13,
1.40)**
' 4 2
7
1.17 (1.12,
1.22)** 222222
 /":04/"6-,"/:7 /":-4/"6,,"/:7
B 
B
2.74 (1.22,
7.84)*
3.49 (1.20,
14.91)*
 ,"3,4/"6.."/37 ,"-;4/";:."007

0.60 (0.36,
0.95)* /"0.4/"33,",-7
8! ,".:4/";;."/67 ,"E:4/"6E.":/7
#
  ,"-;4/"66."307 ,"..4/"0-."./7

1 ,"-04/"60."3:7 /"004/"3/,"307
L
1
2.47 (1.31,
4.36)** ,":04/"66-"/:7
K!
1 .",/4/":,-".E7 ,"0/4/"E;3"::7
9 ,"/,4/".-."6.7 /"E64/"/:.".07
L! +!
L! 4!?7 ,"//4/":;,"/-7
0.95 (0.91,
0.99)*
=>!4?1@7
1.11 (1.04,
1.19)**
1.15 (1.06,
1.26)**
K!47
1.20 (1.13,
1.27)**
1.12 (1.05,
1.21)**
' 4 2
7
1.09 (1.05,
1.12)** 222222
30

1.10 (1.01,
1.19)*
1.10 (1.01,
1.19)*
B 
B ,",/4/";E,"0E7
1.63 (1.01,
2.73)*

1.61 (1.22,
2.12)** ,".-4/"6;,";;7

1.32 (1.01,
1.71)* ,"3E4/":0,":/7
8!
1.44 (1.06,
1.95)* ,"/64/";3,"E07
#
 
2.07 (1.53,
2.78)**
1.66 (1.14,
2.39)**

1
1.80 (1.31,
2.45)** ,"/;4/";/,"0/7
L
1
2.20 (1.43,
3.31)** ,"E04/":3."E07
K!
1
3.65 (2.25,
5.84)**
3.01 (1.68,
5.34)**
9 ,"664/":63"-.7 ,"3;4/"0/.":/7
 4!?7 /"::4/":0,"/.7 /":;4/":3,"/,7
=>!4?1@7 ,"/34/":6,",/7 ,"/34/":0,",,7
K!47
1.08 (1.02,
1.15)** ,"/34/":0,",/7
' 4 2
7
1.04 (1.00,
1.07)* 222222
 ,"/,4/":-,"/:7 ,"//4/":.,"/67
B 
B
1.70 (1.15,
2.60)**
2.52 (1.55,
4.27)**

1.81 (1.39,
2.33)**
1.46 (1.05,
2.03)*
 ,".,4/":E,"EE7 ,"/.4/";-,"3:7
8! 1.60 (1.21, ,".E4/"66,";E7
31
2.11)**
#
 
1.65 (1.23,
2.19)**
1.47 (1.02,
2.09)*

1
1.58 (1.16,
2.12)** ,".34/"63,"6/7
L
1 ,"E-4,"//."3.7 ,"/34/"0/,";/7
K!
1
2.65 (1.63,
4.23)**
2.25 (1.24,
4.00)**
9 ,";;4/":E3",E7 ,"3;4/"0.."6/7
A 
 4!?7 /"::4/":0,"/,7
0.96 (0.93,
1.00)*
=>!4?1@7 ,"/34/":6,"/67 ,"/-4/":;,",,7
K!47 ,"/-4/":6,"/:7 /"::4/":-,"/E7
' 4 2
7 ,"/34,"//,"/07 222222
 ,"/04/"::,",37 ,"/E4/"::,",37
B 
B ,".:4/":-,"6,7
1.70 (1.15,
2.55)**

1.46 (1.16,
1.85)** ,".-4/":3,"007
 ,",/4/"66,"3;7 ,"/;4/"6,,"-,7
8! ,".:4,"//,"007 ,",04/"6E,"E;7
#
 
1.62 (1.25,
2.10)**
1.73 (1.26,
2.37)**

1 ,",64/"6:,"E07 ,"/,4/";,,"-.7
L
1 ,"364/":3."/.7 ,",:4/";E,"607
K!
1
1.76 (1.10,
2.80)* ,"E:4/":..";E7
 9
1.77 (1.01,
3.05)* ,"E64/"6,."::7
32
+!
+ 4!?7
1.03 (1.00,
1.05)* /":64/":E,"/,7
=>!4?1@7
1.16 (1.11,
1.21)**
1.15 (1.09,
1.22)**
K!47
1.18 (1.12,
1.23)**
1.12 (1.06,
1.18)**
' 4 2
7
1.10 (1.07,
1.13)** 222222
 ,"/34/":;,"/:7 ,"/.4/":0,"/:7
B 
B
1.73 (1.30,
2.30)**
1.94 (1.36,
2.78)**

1.41 (1.14,
1.76)**
1.37 (1.04,
1.81)*
 /":E4/";6,",07 /":04/";-,".-7
8! ,",-4/":/,"-E7 ,",.4/"63,"-:7
#
 
1.53 (1.19,
1.97)**
1.52 (1.11,
2.09)**

1
1.57 (1.21,
2.05)**
1.43 (1.03,
1.99)*
L
1
1.81 (1.24,
2.69)** ,".64/"6.."/37
K!
1 ,"E64,"//."E;7 ,"-04/"6,."0:7
9 ,"E-4/"6:.";-7 ,":34/":63":;7
= ! 4!?7 ,"//4/":;,"/.7
0.95 (0.92,
0.99)**
=>!4?1@7
1.07 (1.02,
1.13)**
1.09 (1.02,
1.17)**
K!47
1.10 (1.05,
1.16)** ,"/E4/"::,",.7
' 4 2
7
1.05 (1.02,
1.08)** 222222
33
 ,"/E4/"::,",37 ,"/-4/":;,",.7
B 
B
1.49 (1.07,
2.11)*
2.94 (1.90,
4.70)**

1.44 (1.14,
1.82)** ,"/.4/";E,"367
 ,".34/"::,"E.7 ,".34/":.,"037
8!
1.54 (1.19,
1.98)** ,".E4/":,,";/7
#
 
2.07 (1.60,
2.68)**
1.73 (1.25,
2.39)**

1
1.75 (1.33,
2.28)**
1.44 (1.01,
2.02)*
L
1
1.86 (1.27,
2.71)** ,"3:4/"66.",67
K!
1
3.52 (2.23,
5.59)**
2.62 (1.49,
4.64)**
9 ,"0:4/":0.":,7 ,";,4/"6-3"-,7
@ 4!?7 /"::4/":0,"/.7
0.95 (0.91,
0.98)**
=>!4?1@7
1.08 (1.01,
1.15)*
1.10 (1.02,
1.20)*
K!47
1.10 (1.03,
1.16)** ,"/34/":0,",,7
'
1.04 (1.00,
1.07)* 222222
4 2
7 ,"/.4/":-,",/7 ,"/,4/":3,"/:7
B 
B ,".,4/"63,"6/7
1.93 (1.20,
3.23)**

1.72 (1.31,
2.23)** ,"364/":6,":37
 ,".64/"::,"0-7 ,",04/"63,"0/7
34
8! ,".-4/":,,"0;7 ,"/:4/";E,"E07
#
 
1.47 (1.08,
1.98)* /":-4/"03,"367

1
1.67 (1.22,
2.27)** ,"./4/"6/,";;7
L
1
2.20 (1.45,
3.29)**
1.75 (1.06,
2.82)*
K!
1
3.21 (1.98,
5.12)**
3.23 (1.79,
5.76)**
9 ,"6-4/":;3"3/7 ,"0,4/";-3".;7
*+!
!  4!?7 ,"/,4/":6,"/-7 /"::4/":E,"/37
=>!4?1@7
1.13 (1.06,
1.21)**
1.16 (1.07,
1.26)**
K!47 ,"/-4/":6,",/7 ,"//4/":3,"/;7
' 4 2
7 ,"/.4/"::,"/07 222222

1.11 (1.02,
1.19)*
1.11 (1.03,
1.21)*
B 
B
1.69 (1.12,
2.65)*
2.25 (1.34,
3.95)**

1.60 (1.22,
2.09)**
1.67 (1.18,
2.34)**
 ,"/,4/";6,"3,7 ,"/E4/";E,"-07
8!
1.46 (1.09,
1.95)* ,"-,4/":6."/,7
#
 
1.55 (1.14,
2.09)**
1.63 (1.12,
2.35)*

1 ,".34/"66,"0:7 /"664/"E;,"3.7
L
1 ,"/E4/"0-,"007 /"6;4/"-6,"-:7
K! 1.83 (1.07, ,"6;4,"//3"-,7
35
1 3.02)*
9 ,".,4/"E:.".:7 ,"//4/"-/."./7
*
) 4!?7
1.07 (1.00,
1.13)* /":64/":/,"/07
=>!4?1@7
1.48 (1.22,
1.87)**
1.45 (1.17,
1.89)**
K!47
1.21 (1.08,
1.35)** ,",.4/":;,".67
' 4 2
7
1.12 (1.06,
1.18)** 222222
 ,"/E4/"6:,"..7 ,"/04/"6:,".E7
B 
B ,",34/"E-.";07 ,".;4/"E-3"E.7
 ,"E34/"6;."0,7 ,",:4/"E6."307
 ,"EE4/":.."E;7
1.99 (1.01,
3.86)*
8! ,"-/4/";E."-67 ,"334/"03."007
#
 
2.06 (1.15,
3.56)* ,"0-4/"6/3".,7

1 ,"334/"0;."-07 /";;4/"3.,";/7
L
1 ,"-:4/"E03".07 /":,4/"3/."-,7
K!
1 ."-64/":3E"E.7 ,"6.4/"0/-";67
9 .".64/"0;E"637 ,"064/"3;E"-.7
)
 4!?7 ,"//4/":;,"/.7 /":64/":E,"/,7
=>!4?1@7
1.06 (1.01,
1.11)*
1.06 (1.00,
1.12)*
K!47 ,"/34/"::,"/67 ,"//4/":E,"/07
' 4 2
7
1.03 (1.00,
1.06)* 222222
36
 ,"/-4/":6,",,7 ,"/34/":;,",/7
B 
B
1.59 (1.20,
2.13)**
2.13 (1.49,
3.07)**

1.40 (1.13,
1.74)**
1.37 (1.05,
1.80)*
 ,"/E4/"60,".;7 ,"/,4/";6,".:7
8!
1.36 (1.07,
1.73)* ,".04/":E,"067
#
 
1.45 (1.13,
1.86)**
1.36 (1.01,
1.85)*

1 ,",34/"6;,"-07 /":,4/"00,".E7
L
1 ,"304/":-,":07 ,".,4/";:,"607
K!
1
2.24 (1.40,
3.65)**
2.82 (1.58,
5.23)**
 9
2.05 (1.19,
3.64)** ,":/4,"//3";.7
+!
! 4!?7 ,"/34/"::,"/07 /":;4/":.,"/.7
=>!4?1@7
1.20 (1.11,
1.31)**
1.22 (1.10,
1.37)**
K!47
1.18 (1.10,
1.26)**
1.13 (1.04,
1.22)**
' 4 2
7
1.09 (1.05,
1.13)** 222222

1.18 (1.08,
1.29)**
1.21 (1.10,
1.33)**
B 
B ,"E,4/":3."E:7 ,"304/";;."E07

1.42 (1.02,
1.95)* ,"-E4/":E.",:7
 /"6E4/"0,,",07 /":04/"03,"--7
37
8! /":64/"0;,"-.7 /"0;4/"-,,"/;7
#
  ,"/64/";3,"E;7 /":,4/"E0,"-E7

1
1.77 (1.23,
2.51)**
1.70 (1.06,
2.66)*
L
1 ,".,4/"06."/-7 /";,4/"30,"337
K!
1 ,"0-4/"6E.":-7 ,";-4/"6.3"E,7
9 ,",;4/"-6."-;7 ,"3/4/"-:."::7
K ! 4!?7 ,"/.4/":6,"/07 /":64/":-,"/37
=>!4?1@7
1.15 (1.07,
1.25)**
1.14 (1.04,
1.27)**
K!47
1.16 (1.08,
1.24)** ,"/64,"//,",;7
' 4 2
7
1.07 (1.03,
1.11)** 222222
 ,"/64/"::,",67 ,",/4,"//,"./7
B 
B
2.46 (1.41,
4.73)**
2.28 (1.23,
4.67)**
 ,"./4/"60,"0;7 ,".;4/"6-,":/7
 /":;4/";,,"3.7 ,"./4/"6,,";;7
8! /":34/"03,"3-7 /"6-4/"E3,"3,7
#
  ,".;4/"6;,"6.7 ,"--4/":3.",:7

1 ,",.4/";E,"0-7 ,"//4/"0,,"0/7
L
1
1.69 (1.01,
2.72)* ,"..4/"0E.",;7
K!
1 ,"/34/"-;,"::7 /":-4/"-/,":67
9 ,"3E4/"E6.";E7 ,"-04/"E03".:7
38
@)!!
B  4!?7
1.07 (1.04,
1.09)** ,"//4/":;,"/-7
=>!4?1@7
1.32 (1.24,
1.40)**
1.23 (1.14,
1.33)**
K!47
1.23 (1.17,
1.29)**
1.14 (1.07,
1.21)**
' 4 2
7
1.14 (1.11,
1.17)** 222222

1.12 (1.05,
1.20)**
1.12 (1.05,
1.21)**
B 
B
2.74 (1.86,
4.15)**
2.84 (1.75,
4.79)**
 ,"..4/":0,"E-7 ,"304/"::,"607

0.60 (0.47,
0.75)**
0.61 (0.45,
0.83)**
8! ,"/64/"63,"-/7 ,",:4/"6E,"007
#
  ,".,4/":.,"E67 ,"/-4/";3,"-;7

1
1.44 (1.09,
1.89)* ,".E4/"60,"6/7
L
1
1.76 (1.20,
2.56)** ,"./4/";-,":,7
K!
1
2.00 (1.25,
3.17)**
1.86 (1.01,
3.42)*
 9
2.26 (1.31,
3.88)**
2.63 (1.30,
5.31)**
B
 4!?7 /"::4/":0,"/,7 ,"//4/":;,"/37
=>!4?1@7 /":04/":.,"/,7 /":04/":,,"/.7
K!47 /"::4/":E,"/-7 /"::4/":3,"/-7
' 4 2
7 /"::4/":0,"/.7 222222
39

1.16 (1.09,
1.23)**
1.15 (1.08,
1.23)**
B 
B
0.75 (0.56,
1.00)* /":,4/"0-,".:7

1.55 (1.24,
1.94)**
1.37 (1.04,
1.80)*
 ,"..4,"//,"E/7 /":E4/";3,".37
8!
1.59 (1.25,
2.03)** ,".04/":-,"0;7
#
 
1.69 (1.31,
2.17)** ,"3.4/":;,";:7

1
1.52 (1.17,
1.98)** ,".E4/":/,";,7
L
1 ,"3,4/":/,":,7 /"::4/"0-,"E.7
K!
1
2.12 (1.35,
3.36)** ,"E04/":,.";/7
 9
1.92 (1.12,
3.29)* ,"3/4/"06."-37
 4!?7
1.13 (1.08,
1.18)** ,"/E4/"::,",/7
=>!4?1@7
1.40 (1.24,
1.61)**
1.27 (1.10,
1.51)**
K!47
1.30 (1.21,
1.41)**
1.19 (1.08,
1.31)**
' 4 2
7
1.17 (1.13,
1.22)** 222222

1.20 (1.08,
1.33)**
1.21 (1.08,
1.36)**
B 
B ,",:4/";,.",07 /"::4/"E,."/07
 /":E4/"0.,"-.7 /";E4/"-,,"3.7
 0.68 (0.45, /"0,4/"3E,"/E7
40
0.99)*
8!
1.60 (1.06,
2.36)*
1.78 (1.05,
2.96)*
#
 
1.82 (1.20,
2.70)** ,"004/":;.";E7

1
1.83 (1.19,
2.74)** ,".64/";,.".-7
L
1
2.57 (1.50,
4.21)** ,"E04/";:.":-7
K!
1
2.82 (1.48,
5.03)** ,"E:4/"0:3"-37
 9
2.81 (1.31,
5.48)** ,":/4/";/-"0;7
1 4!?7 ,"/-4/":6,",/7 ,"/,4/":-,"/67
=>!4?1@7 ,"//4/":/,",.7 /":04/"63,",/7
K!47
1.20 (1.08,
1.33)** ,",,4/":6,".E7
' 4 2
7
1.10 (1.04,
1.16)** 222222

1.20 (1.05,
1.36)**
1.17 (1.02,
1.34)*
B 
B ,"-04/";,3"E.7
2.82 (1.13,
8.69)*

1.65 (1.00,
2.66)* ,"/-4/"E3,":;7
 ,".;4/";:."/.7 /":;4/"E.,";67
8!
2.04 (1.22,
3.32)** ,"-04/";6."007
#
 
2.63 (1.59,
4.25)**
1.97 (1.04,
3.61)*

1
1.86 (1.06,
3.12)* ,".:4/"0.."EE7
L 2.68 (1.35, ,";64/";63";07
41
1 4.94)**
K!
1
4.12 (1.98,
7.88)**
2.93 (1.23,
6.59)*
9 ."334/";:E"-:7 /"6E4/",6."667
 4!?7
1.08 (1.05,
1.10)** ,"//4/":;,"/-7
=>!4?1@7
1.34 (1.27,
1.42)**
1.32 (1.23,
1.42)**
K!47
1.14 (1.09,
1.20)**
1.08 (1.02,
1.15)**
' 4 2
7
1.11 (1.08,
1.15)** 222222
 /"::4/":3,"/E7 /"::4/":3,"/07
B 
B
2.24 (1.60,
3.18)**
2.04 (1.36,
3.12)**
 ,",:4/":E,"-:7 ,".;4/":E,"0:7
 /"604/";/,"/07 ,",,4/"6-,"-07
8! ,",04/":/,"-67
1.36 (1.00,
1.85)*
#
  /";:4/"0/,"/.7 /";.4/"E.,"//7

1 ,",34/"60,"-;7 /":;4/"06,"307
L
1
1.59 (1.09,
2.30)* ,",-4/";3,";67
K!
1 ,".-4/";;,":07 ,"3.4/";3."307
9 ,"3.4/";E.".;7 ,"-04/";-."6-7
 4!?7
1.05 (1.03,
1.08)** ,"/.4/"::,"/E7
=>!4?1@7
1.12 (1.07,
1.18)**
1.10 (1.04,
1.16)**
K!47 1.15 (1.10, 1.11 (1.05,
42
1.20)** 1.17)**
' 4 2
7
1.10 (1.07,
1.13)** 222222

1.12 (1.05,
1.19)**
1.12 (1.06,
1.20)**
B 
B ,",04/"66,"EE7 ,"..4/"60,";E7

1.58 (1.27,
1.96)**
1.40 (1.07,
1.84)*
 ,"//4/"6.,"..7 ,"/,4/";6,"3/7
8! ,".04/"::,"0/7 ,"/34/";;,"367
#
 
1.30 (1.02,
1.67)* ,"/64/";:,"-07

1
1.50 (1.16,
1.94)** ,".,4/"66,"007
L
1
1.57 (1.09,
2.27)* ,"/;4/";/,"0E7
K!
1
2.56 (1.60,
4.19)**
2.34 (1.32,
4.30)**
 9
1.88 (1.09,
3.29)* ,"E,4/";:.":-7
@  4!?7
1.12 (1.08,
1.15)** ,"/-4,"//,"/67
=>!4?1@7
1.35 (1.24,
1.48)**
1.22 (1.11,
1.36)**
K!47
1.27 (1.20,
1.35)**
1.21 (1.13,
1.30)**
' 4 2
7
1.17 (1.14,
1.21)** 222222

1.19 (1.10,
1.28)**
1.20 (1.10,
1.31)**
B 
B
2.39 (1.47,
4.13)**
2.29 (1.31,
4.23)**
43

1.36 (1.01,
1.80)* ,"/04/";,,"E07
 /":,4/"0:,",:7 /"664/"0/,".;7
8!
1.96 (1.45,
2.62)**
2.06 (1.41,
2.99)**
#
 
1.55 (1.12,
2.11)** ,",E4/";0,";/7

1
2.20 (1.61,
2.99)**
1.62 (1.07,
2.44)*
L
1
2.30 (1.50,
3.46)** ,"./4/";/."/.7
K!
1
2.46 (1.46,
4.03)** ,";;4/"6:3"--7
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... Peitzmeier et al identified that 53.8% of individuals who bound their chests endorsed back pain, whereas 48.8% endorsed chest pain. 8 Jarrett et al showed that 74.8% of surveyed transmasculine adults who practiced chest binding endorsed at least one pain symptom. 9 Although there is evidence demonstrating the prevalence of pain in people with excess breast development, little is known about the determinants of this pain. ...
... Many individuals report chest pain, back, neck, and/or shoulder pain as well as difficulty participating in sports, respiratory issues, and/or skin problems. 8,9 Similar problems are reported in the cisgender macromastia population, and one of the purposes of this study was to determine if the risk factors for reported pain were similar in cisgender and transgender individuals seeking breast reduction or removal. ...
Article
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Benign breast surgery aims to treat the physical and psychological discomfort that may be associated with excess breast tissue. In this investigation, we present the first systematic examination and comparison of the determinants of pain and related symptomology in cisgender women and transmasculine individuals presenting for benign breast surgery. Methods: To complete this study, we abstracted the intake forms of 128 transmasculine and 62 cisgender female patients who presented for benign breast surgery between August 2016 and July 2020. Results: Increasing chest size was associated with significantly increased odds of reporting rash (OR 1.10 95% CI [1.01-1.10], P < 0.03), difficulty playing sports (OR 1.19 95% CI [1.09-1.29], P < 0.001), and difficulty finding clothes that fit (OR 1.21, 95% CI [1.11-1.33], P < 0.001). For individuals who bound their chests, size was also associated with difficulty exercising in a binder (OR 1.14 [1.01-1.29], P < 0.03). Looking separately at the two populations, the only factors that remained associated with pain in multivariate models were BMI (β = 0.10 [0.01-0.18], P < 0.03) for cisgender women and history of binding (β = 1.95 [0.37-3.52], P < 0.02) for transmasculine people. Conclusions: Pain does not seem to be associated with chest size in either cisgender female or transmasculine patients seeking benign breast surgery. The association between chest binding and pain in transmasculine people supports the provision of gender-affirming chest surgery to eliminate the need to bind and reduce both physical and psychological distress.
... Patients with prior chest surgery 'top surgery' should specifically discuss infant feeding options given potential to affect breast/chestfeeding [65]. Additionally, TGNB individuals should be counseled about the wide range of body changes that can occur. ...
... Chest binding, or using material to flatten the chest contour, is anecdotally common among TGNB people [65,66]. This can cause plugged lactation ducts and mastitis and patients should be counseled on these risks. ...
Article
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Purpose of review: The visibility of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities, specifically the transgender and nonbinary (TGNB) communities, continues to grow. However, there is little description, much less guidance toward optimizing, the pregnancy-related care of TGNB people. The overarching goal of this paper is to provide guidance that aids in reimagining obstetrics to include people of all genders. Recent findings: This article will review current literature and provide recommendations specific to the hospital birthing environment to help address the lack of knowledge regarding pregnancy-related care of TGNB individuals. This care is further divided into three main times: (1) preconception, antepartum care, and triage, (2) intrapartum, and (3) postpartum. We also discuss considerations for the general medical care of TGNB individuals. Summary: Understanding facilitators and barriers to gender affirming pregnancy-related care of TGNB individuals are first steps toward providing a respectful, affirming, and evidence-based environment for all patients, especially TGNB individuals. Here we provide context, discussion, and resources for providers and TGNB patients navigating pregnancy-related care. Lastly, this review challenges researchers and clinicians with future directions for the care of TGNB individuals in this continually expanding field.
... There has been relatively little research on aspects of gender affirmation that are outside of the field of medicine. We have identified the following three important areas as needing further research, which have also been recognized as gaps in our knowledge in recent publications (Block et al., 2018;Blotner & Rajunov, 2018;Iwamoto et al., 2019;Peitzmeier et al., 2017;Zwickl et al., 2019): ...
Article
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Background: This article is by a group of trans and nonbinary researchers and experts in the field of trans health who have conducted an analysis of trans health research needs. Aims: To highlight topics that need further research and to outline key considerations for those conducting research in our field. Methods: The first author conducted semi-structured interviews with all co-authors, and these were used to create a first draft of this manuscript. This draft was circulated to all authors, with edits made until consensus was reached among the authors. Results: More comprehensive long-term research that centers trans people's experiences is needed on the risks and benefits of gender affirming hormones and surgeries. The trans health research field also needs to have a broader focus beyond medical transition or gender affirmation, including general health and routine healthcare; trans people's lives without, before, and after medical gender affirmation; and sexuality, fertility, and reproductive healthcare needs. More research is also needed on social determinants of health, including ways to make healthcare settings and other environments safer and more supportive; social and legal gender recognition; the needs of trans people who are most marginalized; and the ways in which healing happens within trans communities. The second part of this article highlights key considerations for researchers, the foremost being acknowledging trans community expertise and centering trans community members' input into research design and interpretation of findings, in advisory and/or researcher roles. Ethical considerations include maximizing benefits and minimizing harms (beneficence) and transparency and accountability to trans communities. Finally, we note the importance of conferences, grant funding, working with students, and multidisciplinary teams. Discussion: This article outlines topics and issues needing further consideration to make the field of trans health research more responsive to the needs of trans people. This work is limited by our authorship group being mostly White, all being Anglophone, and residing in the Global North.
... There has been relatively little research on aspects of gender affirmation that are outside of the field of medicine. We have identified the following three important areas as needing further research, which have also been recognized as gaps in our knowledge in recent publications (Block et al., 2018;Blotner & Rajunov, 2018;Iwamoto et al., 2019;Peitzmeier et al., 2017;Zwickl et al., 2019): ...
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Background: This article is by a group of trans and nonbinary researchers and experts in the field of trans health who have conducted an analysis of trans health research needs. Aims: To highlight topics that need further research and to outline key considerations for those conducting research in our field. Methods: The first author conducted semi-structured interviews with all coauthors, and these were used to create a first draft of this manuscript. This draft was circulated to all authors, with edits made until consensus was reached among the authors. Results: More comprehensive long-term research that centers trans people’s experiences is needed on the risks and benefits of gender affirming hormones and surgeries. The trans health research field also needs to have a broader focus beyond medical transition or gender affirmation, including general health and routine healthcare; trans people’s lives without, before, and after medical gender affirmation; and sexuality, fertility, and reproductive healthcare needs. More research is also needed on social determinants of health, including ways to make healthcare settings and other environments safer and more supportive; social and legal gender recognition; the needs of trans people who are most marginalized; and the ways in which healing happens within trans communities. The second part of this article highlights key considerations for researchers, the foremost being acknowledging trans community expertise and centering trans community members’ input into research design and interpretation of findings, in advisory and/or researcher roles. Ethical considerations include maximizing benefits and minimizing harms (beneficence) and transparency and accountability to trans communities. Finally, we note the importance of conferences, grant funding, working with students, and multidisciplinary teams. Discussion: This article outlines topics and issues needing further consideration to make the field of trans health research more responsive to the needs of trans people. This work is limited by our authorship group being mostly White, all being Anglophone, and residing in the Global North.
Article
Transgender and gender diverse (TGD) individuals may undergo a wide range of care during gender transition including mental health counseling, gender-affirming hormonal therapy, and various surgeries. Hormone therapy effectively converts the hormonal milieu into that of the affirmed gender and produces measurable alterations in serum markers for coronary artery disease and other hematologic conditions (eg, erythrocytosis, venous thrombosis). Although illegal in the United States, some transgender women may receive silicone injections for breast and soft tissue augmentation, which can lead to devastating local complications, as well as silicone migration, pulmonary embolism, systemic reactions, and death. Smoking rates are higher among transgender and sexual minority populations, placing them at elevated risk of smoking-related diseases, including lung cancer. Some opportunistic infections may be more common in the TGD populations, attributable to higher rates of coexisting infection with human immunodeficiency virus. Radiologists should be aware that these patients may develop cancer of their natal organs (eg, breast, prostate), especially as some of these tissues are not completely removed during gender-affirming surgery, which may manifest with thoracic involvement by secondary neoplasia. As more TGD patients seek medical care, thoracic radiologists can reasonably expect to interpret imaging performed in this population and should be aware of possible disease processes and potential complications of hormonal and surgical therapies.
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When we think of cyborgs, we might conjure up the collective hive-mind of The Borg from ‘Star Trek’, or science fiction writer Alastair Reynold’s chimeric starship residents, half their bodies taken up by prosthetic limbs and organs. Cyborgs are futuristic meldings of the biological and the artificial; something created rather than evolved. Or are they?
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Introduction: Chest binders are an important resource for building masculinity in transgender men without mastectomy, although they can cause respiratory and thoracic damage if misused. Objective: To analyze the association between chest binding and chest complaints in transgender men. Methods: This was a quantitative cross-sectional study conducted at the Trans Space of the Hospital das Clínicas de Pernambuco and the LGBTQI Patrícia Gomes outpatient clinic of the Lessa de Andrade polyclinic in Recife (Pernambuco State, northeastern Brazil). Sixty transgender men aged >18 years were included, and data on sociodemographics, general health, chest binding, and respiratory complaints in the thoracic region were collected. Descriptive analysis was performed, and prevalence ratios (PR) were estimated with a confidence interval (CI) of 95% to associate between binder use and complaints in the chest region. Results: The average was 27.25 years, of which 81.7% did not undergo mastectomy and 53.3% used chest binders. The use of chest binders was significantly associated with complaints in the chest region (PR = 2.73), difficulty breathing (PR = 2.27), and chest pain (PR = 1.82). Conclusion: This study demonstrated a higher prevalence of complaints in the chest and respiratory region in transgender men who use chest binders. This reinforces the need to broaden the view on the health of this population. Gender construction strategies are essential for the quality of life and mental health of transgender men, and binders are an important ally in this process.
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The Gender Identity Development Service (GIDS) supports gender diverse young people, and their families but currently does not provide weekly psychological therapy as part of its core work. In addition, local Child and Adolescent Mental Health Services (CAMHS), may feel deskilled in providing support for this population. We, a group of three Clinical Psychologists, aim to share some common themes and observations gained from our work in GIDS. We talk about how existing Cognitive Behavioural Therapy (CBT) models can be relevant and helpful for the challenges facing gender diverse young people, without pathologising, or aiming to change a young person’s gender identity. An illustrative case study is presented, based on an amalgamation of young people we have worked with highlighting how third-wave cognitive behavioural theory, ideas and practice can be used to support young people to manage gender-related distress. Further reflections on the broader socio-political context, and implications for clinical practice and future research are discussed.
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Chest binding or ‘binding’ is a practice used by many trans and nonbinary people assigned a female sex at birth to achieve a flatter chest contour and affirm their gender. Binding allows individuals to affirm their gender in a temporary, reversible way. While many individuals who bind report negative physical symptoms, binding also often carries significant benefits for mental health and safety. In this commentary, we explain what the data do and do not say about the physical risks of binding and describe how decreasing stigma around binding will substantially reduce physical risks associated with binding and increase the benefits of the practice. As with any intervention, individuals should make an informed decision about the risks and benefits of binding. If negative physical symptoms arise, individuals can consider adjusting their binding practice or working with a healthcare provider to address these concerns.
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This Briefs is the first national study on female-to-male (FtM) transgender people’s experiences in Australia. It describes an extensive study that fills the current gap in Australian research on the specific experiences and beliefs about transition for contemporary Australian FtM transgender people. Following an overview of current literature on the various aspects of and approaches to transgender issues, this briefs describes in detail the design, participants and findings of the study. The Briefs offers useful statistics and stories related to participants' identities, education, health, sexual and social lives. It ends with recommendations to all those working in the various offices and institutions that FtM transgender people encounter in their everyday life, and represents and invaluable resource for researchers, service providers and gender diverse communities alike.
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A United States sample of 166 transgender adults including 50 male-to-females (MTFs), 52 female-to-males (FTMs), and 64 genderqueers (neither completely female nor completely male), were surveyed about identity development, levels of disclosure of transgender status, and relationship to community. There was no difference among transgender groups in age of first experiencing oneself differently from assigned birth sex. MTFs first identified as other than their assigned sex earlier than FTMs. However, they did not present themselves to others in a gender-congruent way until much later than FTMs. MTFs were less likely to disclose their gender identity to their parents than were FTMs. Disclosure of assigned birth sex was more common among younger participants. There was no difference in the extent to which individuals felt connected to the transgender community. Genderqueers felt more connected to the lesbian, gay, and bisexual community than did MTFs or FTMs. Implications for health care professionals and transgender communities are discussed.
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The internet has tremendous potential to achieve greater social equity and empowerment and improve everyday life for those on the margins of society. This article presents the findings from three digital divide studies, each of which represents a different group of marginalized society members. Low-income families, sexual minorities and African-American women are represented in the three studies that employ different research approaches towards a common aim of contextualizing internet use in the everyday social practice of society’s ‘have-nots’. The aim is to step outside simple digital divide categories to understand how marginalized members of society incorporate computers and the internet into their daily lives in ways that are meaningful to them. An important goal is also to learn about how internet researchers can contribute to closing the digital divide in ways that converge with the goals, meanings and practices of people living on society’s margins.
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There is a dearth of health research about transgender people. This mixed-methods study sought to formatively investigate the health and perceived health needs of female-to-male transmasculine adults. A cross-sectional quantitative needs assessment (n = 73) and qualitative open-ended input (n = 19) were conducted in June 2011. A latent class analysis modeled six binary health indicators (depression, alcohol use, current smoking, asthma, physical inactivity, overweight status) to identify clusters of presenting health issues. Four clusters of health indicators emerged: (a) depression; (b) syndemic (all indicators); (c) alcohol use, overweight status; and (d) smoking, physical inactivity, overweight status. Transphobic discrimination in health care and avoiding care were each associated with membership in the syndemic class. Qualitative themes included personal health care needs, community needs, and resilience and protective factors. Findings fill an important gap about the health of transmasculine communities, including the need for public health efforts that holistically address concomitant health concerns.
Book
CHOICE MAGAZINE Outstanding Academic Title for 2007 The field of "transgender" and "transpositionality" has been carved out as a new field of inquiry in the past decade, showing the fragmentation and diversification of masculinities and feminities - along with the error of any sharp polarisation. Dave King and Richard Ekins are the leading world sociologists in this field and have mined it richly since the 1970's. The book brings together a brilliant synthesis of history, case studies, ideas and positions as they have emerged over the past thirty years, and brings together a rich but always grounded account of this field, providing a state of the art of critical concepts and ideas to take this field further during the twenty first century. This is a must read for all interested in this new area of inquiry ' - Ken Plummer, Professor of Sociology, University of Essex. Editor of Sexualities. Author of Intimate Citizenship An outstanding survey of the evolution of trans phenomena, splendidly written, highly informative, scholarly at its best, yet easy to read even for those neither trans nor sociologist. Drs Ekins and King, experts in the field, unroll the panoramas of sex, gender, and transgendering that have evloved during the last decades. For everyone wanting to understand the interaction of women and men and of those who cannot or will not identify with either of these two cataegories, reading this book is a must, and a real pleasure' - Professor Friedmann Pfaefflin, University of ULM In a work destined to be a classic, Ekins and King offer a comprehensive overview of the diversity of contemporary transgender expression, along with an impressive conceptual framework for making sense of that diversity. The abundant case vignettes bring the authors' concepts to life and make the book a pleasure to read' - Dr Anne Lawrence, Clinical Sexologist in Private Practice, Seattle An outstanding survey of the evolution of trans phenomena, splendidly written, highly informative, scholarly at its best, yet easy to read even for those neither trans nor sociologist. Drs Ekins and King, experts in the field, unroll the panoramas of sex, gender, and transgendering that have evloved during the last decades. For everyone wanting to understand the interaction of women and men and of those who cannot or will not identify with either of these two cataegories, reading this book is a must, and a real pleasure' - This groundbreaking study sets out a framework for exploring transgender diversity for the new millennium. It sets forth an original and comprehensive research and provides a wealth of vivid illustrative material.Based on two decades of fieldwork, life history work, qualitative analysis, archival work and contact with several thousand cross-dressers and sex-changers around the world, the authors distinguish a number of contemporary transgendering stories' to illustrate:" the binary male/female divide;" the interrelations betwen sex, sexuality and gender;" the interrelations between the main sub-processes of transgendering. Wonderfully insightful, The Transgender Phenomenon develops an original and innovative conceptual framkework for understanding the full range of the transgender experience.
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This book chapter was published in the Technologies of Sexuality, Identity and Sexual Health [© 2012 Taylor and Francis] and the definite version is available at: http://www.tandfebooks.com/isbn/9780203121689
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Subcutaneous mastectomy is one of the first steps in sexual reassignment in female-to-male transsexuals (FTMTS). The main goal is to masculinize the chest by removing the female contour. In this study, we introduce an algorithm to facilitate choosing the appropriate mastectomy technique depending on morphological aspects. The records of 173 patients (346 mastectomies) from January 2008 to December 2013 were retrospectively reviewed. The authors conducted four different surgical techniques depending on breast volume, grade of ptosis and skin elasticity. The outcome parameters such as complication rate, patient satisfaction with the aesthetic result, nipple sensitivity and surgical correction rate were obtained and related to the employed technique. From January 2008 to December 2013, we performed 346 mastectomies, of which 48 breasts (13.9%) were treated by a semicircular incision in combination with water-jet-assisted liposuction, 66 breasts (19.1%) by an additional circumferential mastopexy, 170 breasts (49.1%) by an inferior pedicled mammaplasty and 62 breasts (17.9%) by mastectomy with free nipple grafting. The mean operation time lasted 103.6 min. The overall complication rate was 11.8%. Secondary revisions were necessary in 9%. Of the patients, 88% rated the aesthetic results as "very good" or "good." Nipple sensitivity was rated as "very good" or "good" in 80.3% of the breasts. FTMTS are a well-informed patient population and therefore increasingly more demanding for aesthetic outcomes. If possible, the most scar-saving procedure should be preferred. With ascending degrees of ptosis, a larger skin envelope and lesser elastic skin, an extended-incision technique is required. The presented surgical algorithm facilitates the selection of the appropriate mastectomy technique and shows a high patient satisfaction with the aesthetic result, a preservation of nipple sensitivity and a low rate of complications and secondary aesthetic corrections. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Article
Executive Summary Increasing numbers of population-based surveys in the United States and across the world include questions that allow for an estimate of the size of the lesbian, gay, bisexual, and transgender (LGBT) population. This research brief discusses challenges associated with collecting better information about the LGBT community and reviews eleven recent US and international surveys that ask sexual orientation or gender identity questions. The brief concludes with estimates of the size of the LGBT population in the United States. Key findings from the research brief are as follows:  An estimated 3.5% of adults in the United States identify as lesbian, gay, or bisexual and an estimated 0.3% of adults are transgender.  This implies that there are approximately 9 million LGBT Americans, a figure roughly equivalent to the population of New Jersey.  Among adults who identify as LGB, bisexuals comprise a slight majority (1.8% compared to 1.7% who identify as lesbian or gay).  Women are substantially more likely than men to identify as bisexual. Bisexuals comprise more than half of the lesbian and bisexual population among women in eight of the nine surveys considered in the brief. Conversely, gay men comprise substantially more than half of gay and bisexual men in seven of the nine surveys.  Estimates of those who report any lifetime same-sex sexual behavior and any same-sex sexual attraction are substantially higher than estimates of those who identify as LGB. An estimated 19 million Americans (8.2%) report that they have engaged in same-sex sexual behavior and nearly 25.6 million Americans (11%) acknowledge at least some same-sex sexual attraction.  Understanding the size of the LGBT population is a critical first step to informing a host of public policy and research topics. The surveys highlighted in this report demonstrate the viability of sexual orientation and gender identity questions on large national population-based surveys. Adding these questions to more national, state, and local data sources is critical to developing research that enables a better understanding of the understudied LGBT community.