Chennai: Even as a child, Hayan knew that he was different from other children. Assigned female at birth, he identified more with boys. As he grew up, he was attracted only to girls. Then puberty hit, and as his body changed, Hyan began feeling increasingly distressed.
“I was devastated. My breasts grew, my body was changing in ways I didn’t like. While showering I couldn’t bear to look at myself,” says the 20-year-old trans man who lives in Kochi. “I had to wear a T-shirt while playing basketball and didn’t want my breasts to be visible. So, when I was 14, I began binding my chest to flatten my curves, and look more masculine.”
Many trans people experience gender incongruence — a marked and persistent incongruence between the gender felt or experienced by a person, and the gender associated by society with the sex they were assigned at birth.
That’s why chest binding – where people use binders to flatten their chest – is a common practice among transmasculine persons. However, binders are expensive, so they often use crepe and/or ACE bandages, or rough cloth instead. This can cause skin irritation, and also, if wound too tightly, impair their ability to carry out normal activities. Binding for very long hours has been known to cause rib fractures in a few people.
Ludhiana-based trans man Riyam Jain is working to create a more affordable chest binder
“Most trans men in India use crepe bandages to bind their breasts. It’s not a proper binder so you feel uncomfortable,” says Hayan who used to bind his chest tightly while playing basketball in school. “I would feel dizzy. Keeping it on for six to seven hours during school meant that, after a week, my skin would peel off. And I would still wrap it over my wounds the next day.”
Dealing with gender incongruence is tough. “Some people identify with the gender corresponding to their birth-assigned sex, while others identify with another gender,” says Chennai-based psychiatrist Dr N Rangarajan
However, their hormonal system will cause the development of secondary sexual characteristics of a woman. “This will have a severe psychological impact on the person, and they may use binders to flatten their breasts,” he says.
Nivin Kumar, a trans man working as a software engineer in Bengaluru, remembers binding his chest when he was 17. “I hit puberty only when I was in class 10. I was a gymnast and had special tape that I used to bind my feet to avoid injury. I used it to bind my chest and it would leave imprints on my skin, and cause rashes. It was uncomfortable but I slowly got used to it,” says the 22-year-old.
Now you can buy binders online but they are expensive. “The cheapest one costs about Rs 3,000. Many trans men are rejected by their families and don’t have jobs, so it is difficult to spend so much on a binder, so they use cheap stuff,” says Hayan.
That’s why Ludhiana-based trans man Riyam Jain is working on creating a more affordable chest binder. “I used ACE bandages to bind my chest. It chafes your skin, you have constant pain in your chest and ribs, and it makes normal activities such as lifting things or running very difficult,” says Jain, who bought his first binder online when he was in college. “I paid Rs 4,500 but was euphoric. The binder was like a tank top, which compressed my chest muscles and was elastic and comfortable.”
Jain now wants to create a binder that is more breathable and suitable for the Indian climate as well as body type. “Foreign brands have binders for workouts and daily use but I am trying to create a single variant for both activities,” says Jain who plans to roll it out by January 2024. “It’s an intimate garment and people need more than one so I will make it more affordable.”
His team, which consists of nine community members from across the country, is also working to sensitise mental health practitioners. “We want them to become more aware of chest binding and the impact it has on trans, non-binary and androgynous people,” he says.
However, practising chest binding can cause damage to the breast tissue, says plastic surgeon Dr Umang Kothari. “When trans men who have been using chest binders come for mastectomies, we have to assess the size of the breast tissue. If they are small-breasted, chest binders may not do much harm, but it can cause skin damage, loss of skin elasticity and a lot of structural damage in people with medium or heavy breasts,” says Dr Kothari, founder-director, The Gendercare Clinic, Mumbai.
The breast becomes more vertical than round, which can sometimes offset the post-operative outcome, he adds. “If I take out a good amount of fat in a keyhole surgery, there is minimal scarring, and the skin will constrict equally from all around. But, in heavier-breasted individuals using binders for a long period of time, the skin in the upper part of the breast will be more than in the lower part, so I will have to do a double incision mastectomy, which leads to a scar on the chest wall,” says Dr Kothari, who has trans men and trans women from across the world flying down for surgeries.
Hayan, who is on hormone replacement therapy (HRT) and planning to get a mastectomy done soon, stopped binding a few years ago. “I read an article that showed how it can impact breast tissue and make a mastectomy more difficult. And I also realised that the shape of your body doesn’t determine your gender. In fact, there are some people who don’t even opt for sex reassignment surgery,” he says, adding that he now uses a sports bra.
Mental health professionals can help people deal with gender incongruence. “Supportive therapy where their feelings are validated will help. Psychiatrists can also guide them to appropriate clinics where they can have HRT or sex reassignment surgery done in a professional manner,” says Dr Rangarajan.
