December 2019 – Purple and Green and the Life in Between

Wearing a Binder: Recommendations and Exercises

If you haven’t read it yet, check out Wearing a Binder: Physiological Effects. I will refer to the same areas of the body and some of those effects in this post.

GENERAL RECOMMENDATIONS

Try to wear it as short a time as possible. Most recommendations state no longer than 8 hours but if you work 8 or 10 or 12 hour days, that just isn’t possible. Just know that the longer you wear it, the worse the above effects will be.
Try to wear it as few days as possible. If you have severe dysphoria and can’t leave the house without a binder on, try to have one day a week where you stick close to home so you can stay binder free. Or try other slightly less compressive options as many days of the week as possible.
Avoid exercise while wearing a binder. Your lungs cannot expand the way they need to during exercise which forces your heart rate to go up significantly more to compensate. Also, you will have poor spinal and shoulder mobility, causing stress and damage to other joints, muscles, and tendons.
Do not bind while sleeping. When we sleep we are not aware of discomfort. You could be causing damage and not know about it. Also, while you are unconscious and thus not aware of dysphoria, this is the ideal time to take a break from binding.
Never bind with ace bandages. The tension in the wrap can shift over time causing one layer to loosen and another to tighten beyond what is safe.

EXERCISES

Deep breathing

Benefits lungs, ribs, and pelvic floor.

For the following exercises:

Best done in a seated position but can be done lying on your back.
If you start to get light-headed, breathe normally until it clears.
If you have COPD, skip the first exercise and focus on breathing all your air out between each deep breath in.

Active Breathing Cycle

Take a deep breath
Hold it in for 2-3 seconds
Let all the air out by compressing the lungs until they are empty
Take a full deep breath, then breathe normally for 5 breaths
Repeat 3-5 times

Diaphragmatic breathing

Place a hand on your upper belly, just below your breastbone
On each breath in, take a deep breath, pushing your tummy out into your hand
Try to minimize the rise or widening of your chest
Try to only move your tummy to breathe
Cycle of 5 belly breaths and 3 regular breaths
Repeat 3-5 times

Lateral Costal Breathing

This one is a little harder and may take some practice
Place your hands on the sides of your ribs (either by bending your elbows or giving yourself a hug)
On each breath in, take a deep breath, trying to make your chest as wide as possible and pushing your ribs out into your hands
Try to minimize the rise of your chest and the expansion of your belly
Cycle 5 wide breaths and 3 regular breaths
Repeat 3-5 times

Spine and rib movements

Restores general mobility to the spine and ribs.

Thoracic Side Bending

In a seated position, hold on hand on your ribs at the side.
Bend towards that hand, bringing the other arm up and over your head.
Hold stretch for 10-20 seconds while breathing deeply.
Repeat to the other side.
Repeat each side 3-5 times.

Thoracic Rotation

In a seated position, cross your arms high on your chest so you’re grasping your shoulders.
Gently rotate as far as you can one way, and then slowly as far as you can the other way.
As you go, you should feel less resistance and be able to rotate a bit further without pain or muscle cramping.
Repeat 15-20 times.

Flexion and Extension

In a seated position, reach forward, curling your neck, shoulders, and upper back as you breathe out.
Take a deep breath in, opening your arms, pulling your shoulders back, and arching your upper back.
Complete 5 repetitions, take a break to breathe normally for 3-5 breaths, then repeat 2 more times.

Spinal Twist

Lie on your back on a carpet or mat with your knees bent up and your arms spread out on the floor.
Keeping your shoulders flat on the floor, let your knees, hips, and lower back rotate down to one side.
Take a deep breath in and out, then pull your knees up and rotate them the opposite direction.
Alternately, you can start by lying on one side and, keeping your knees on the floor, lift the top arm and rotate your shoulders across to try and get them flat on the mat and then repeat on the opposite side.
Repeat 5-10 times.

Neck Range of Motion

Tip your ear to your shoulder, roll your head down to the middle, then the opposite ear to your shoulder, and back up to the middle.
Breathe slowly and evenly throughout.
Pay attention to where you feel muscle pull. Don’t force the stretch in these areas but pause in the circle to take a full breath in and out in these areas.
Repeat 5-10 times, alternating direction.

Chin Tuck and Neck Extension

Without looking down or bending your neck forward, tilt your head to tuck your chin in (like you’re trying to create a double chin).
With one or both hands, grasp the back of your head and gently pull up. You should feel a stretch right at the base of your skull.
You can also add a bit of sideways pull.
Hold the stretch for 5-10 seconds. Repeat 3-5 times.

Spine mobilization

Targets the thoracic (mid) spine and posterior ribs to decrease stiffness and stretch the ligaments.

For the following exercises:

You will need a foam roller
You will be lying on your back on a carpet or mat with your knees bent up and your feet on the floor with the foam roller horizontal under your spine.
Only put pressure on the spine where the ribs connect to the spine, not down on the lower back or up on the neck.

Spine Rolling

Lift your hips of the mat so the only place of contact is your feet and the roll.
With your hands behind your head or crossed over your chest, gently roll up and down the roll by walking your feet along the floor while breathing deeply.
Spend more time in areas that feel stiff or sore.
Repeat 10-15 times.

Foam Roller Extension

Place the roll just above your bottom ribs.
Take a deep breath in, then slowly arch back over the roll as you breathe out. Only go as far as you are comfortable.
In the arched position, take a full deep breath in and arch a bit more when you breathe out.
Return to the start position and move the roll slightly higher on your spine. Repeat.
It should take 4-6 repetitions in different spots to cover your spine up to the shoulder blades.
Repeat the whole spine 3-5 times.

Shoulder mobility and mechanics

Shoulder and Arm Circles

Roll your shoulders forward, up, back, and down. Repeat 10 times.
Picture a clock face on your shoulder where 12 is up, 3 is forward, 9 is back, and 6 is down. Pull your shoulders into the 10:30 position. Hold them there while you raise your arms up to the sides.
With your shoulders stable and your thumbs pointing up, move your arms in circles from big to small and back to big. Change direction and go big to small to big again. Repeat 3-5 times.

Protraction and Retraction

Give yourself a hug, grasping your shoulders and pulling them forward to stretch your back. Take a deep breath in and out.
Pull your arms back and squeeze your shoulder blades together, stretching your chest. Take a deep breath in and out.
Repeat 5-10 times.

Overhead Reach with Scapular Rotation

Raise one arm out to the side and overhead.
Focus on rotating your shoulder blade so the point of your shoulder moves towards your ear.
Place your other hand just below your armpit. You should feel the edge of your shoulder blade push into your hand.
Repeat 5-10 times each side.

Don’t feel like you have to do all of these every day. Pick a few and do what is manageable. Focus on the ones that treat the area that is causing the most pain for you. The more you do them, the better.

If you have any questions, please leave me a comment and I will clarify or provide modifications. If you have any other exercises that you have found helpful, please also share those in the comments!

Processing…

Success! You're on the list.

Whoops! There was an error and we couldn't process your subscription. Please reload the page and try again.

Wearing a Binder: Physiological Effects

Wearing a binder is sometimes the only way that a person with dysphoria related to having breasts can leave the house. The psychological and emotional impacts of dysphoria are often worse than the physical discomfort from the binder. But that doesn’t mean we should ignore the binder’s effects on our body.

I strongly believe that the more you know about something, the more you can do to make it better.

If you are someone who wears a binder, occasionally or regularly, and just suffers through the physical discomfort in order to manage dysphoria, I’m here to tell you there are ways to make the physical pain less. I can’t guarantee the strategies I talk about will get rid of it, but they will prevent worsening and decrease the pain.

This post is not designed to scare you. It is designed to give you accurate anatomical and physiological information about the various ways a binder can affect your body. In the next post, I will give you concrete ways to minimize these effects.

Disclaimer: I am a physiotherapist and as such have a strong understanding of anatomy and physiology. I am someone who wears a binder and has experienced these effects. I have not done any scientific research on the effects of binder use nor read any scientific research on this topic. I have attended a lecture by researchers who have looked at binder use and I have talked to many trans people about their experiences.

LUNGS

Your lungs are like an upside down tree. They have a main trunk, large branches, then smaller branches, all leading to little round bubbles called alveoli. They are roughly pyramid shaped with the smallest part at the top by your collar bone and the largest part in line with the bottom of your breastbone. They are a self-cleaning organ that requires a consistent exchange of clean air to remain healthy.

When you wear a binder, your lungs cannot expand to their full capacity. The restriction is mostly in a circle around the widest part of the lungs. In order to breathe, you have to expand more through the upper parts of your lungs which are much smaller. This restricts your body’s ability to get more oxygen when exercising and can make you lightheaded. The parts of your lungs that stay closed can become sticky and develop mucus which holds and breeds bacteria. Without taking time to fully expand your lungs when you take off the binder, this could develop into a chronic cough or pneumonia.

SPINE

Your spine is made of vertebrae stacked on top of each other with discs between the bodies and many ligaments and muscles connecting them together. It has a natural inward curve in the neck, outward curve in the upper back, and inward curve in the low back. The different areas of the spine are designed to move in different ways but over all it can bend forward and back, side to side, and rotate. These large movements are created by a small amount of movement between each vertebra.

When you wear a binder, it restricts the movement in the mid spine or upper back forcing the areas above and below to compensate and move more. The areas above and below become hypermobile which can cause pain. Because of the lack of movement in the mid-spine (the section under the binder), the ligaments and muscles become tight, short, and weak which will cause stiffness and pain even when not wearing the binder.

RIBS

Your ribs connect to your spine in the back and your sternum in the front. The joints in the front are more flexible than the ones in the back. The ribs are designed to move out and up when we breathe in. They have ligaments connecting them to the spine, cartilage connecting them to the sternum, and muscles connecting them to each other.

When you are wearing a binder, your ribs are restricted and compressed. The ligaments and muscles can tighten and shorten over time, decreasing your lung capacity even when not wearing the binder. The joints at your spine stiffen up, forcing the joints at the front to move more than they should in order to expand your chest to breathe. This can cause sharp pain by the sternum, or costochondritis. If you use something other than a safe binder to bind with, wear a binder that is too small, or wear your binder too long or too often, you can also cause fractures in your ribs.

SHOULDERS

Your shoulders are designed to have a large range of motion. In order to do get your arms above shoulder height and reach above your head, the structures around the shoulder have to rotate up and out of the way. This includes the shoulder blade, collar bone, and upper ribs. When these three structures rotate up, the tip of your shoulder comes towards your ear.

When wearing a binder, there is more pressure downwards on the collar bone and compression around the ribs. There can also be tension on the skin under your arm and around your shoulder. This all causes restriction in the ability of those structures to move up and rotate when you raise your arm. This can lead to a feeling of weakness in your arm, pain at the shoulder joint from tendons being pinched, and a loss of the body’s natural mechanics, and therefore strength, for overhead movements.

PELVIC FLOOR

Your pelvic floor is made up of many different muscles that form the bottom of your abdominal and pelvic cavity. If you think of this cavity as a pop can, the diaphragm is the top and the pelvic floor is the bottom with the abdominal muscles forming the sides and your organs inside. When you take a deep breath in, your diaphragm pushes down on your abdominal organs, increasing the pressure in the abdomen and pelvis. Your abdominal muscles and pelvic floor muscles absorb this pressure by expanding slightly while maintaining their contraction.

When wearing a binder, your diaphragm is not able to flatten fully and you are unable to take a full deep breath. This means that your pelvic floor muscles do not get the regular exercise of maintaining a contraction while stretching. They become weaker, tighter, and shorter. This can lead to pelvic pain from trigger points in the muscles, pain on penetration, and sometimes incontinence.

RECOMMENDATIONS AND EXERCISES

Again, this post was not designed to scare you. In Wearing a Binder: Recommendations and Exercises, I give you concrete ways to minimize these effects – general recommendations for binder use and a variety of exercises I recommend to counteract some of the effects discussed above.

Processing…

Success! You're on the list.

Whoops! There was an error and we couldn't process your subscription. Please reload the page and try again.

The Coming Out Equation

Coming out is not a one time thing. The closet metaphor may be accurate for how it feels with each instance but it is not a good metaphor for the lifelong process and constant decisions.

Coming out is a matter of degrees. You can be completely open about your identity or experience or just hint at one part of it. You can also be out to a different extent to different people.

Deciding how ‘out’ to be can be a complicated process. How ‘out’ is it safe to be in this situation? How much energy do you have for the questions that will follow? Is it worth the risk? How much benefit will all the effort give you?

The way I see it, it is a matter of need and benefit on the ‘pro’ side vs cost and risk on the ‘con’ side. For me, this equation usually tips to the con side at the moment. But I’ve been working on being more aware of the balance and, when it does tip to the pro side, taking the opportunity to come out to more people.

PROS

Need

Because my gender shifts between male and female so I am comfortable being seen as female about 30% of the time. When I am uncomfortable it is a moderate discomfort so my need to come out is at a low to moderate level at the moment.

Benefit

The benefit of coming out is always hard to determine accurately. It is hard to predict the future. Some things that can help is seeing out people respond to hypothetical conversations or how they respond to a mutual friend or family member coming out before you do.

As a nonbinary person, the benefit of people accepting me for who I am 100% of the time would be just as strong as for any binary trans person but the likelihood of that happening is significantly less. This is simply due to the lack of awareness and the reliance on the binary for so many aspects of western society (see my posts on passing as non-binary and how to explain your fluid gender identity for more discussion on this). So, while the benefit would be huge, I would generally rate it as low likelihood of receiving that benefit.

CONS

Cost

I think of the cost of coming out as an emotional cost. How much effort will it take to get people to understand and eventually lead to the benefits? For similar reasons to the benefit being low, the cost of coming out for me is generally high. I am often the first nonbinary person they have met so I have to start at gender 101 for them to understand why it’s important what I’m saying and why it’s important that they make an effort to use they/them pronouns.

The other thing to take into account in terms of emotional cost is how it feels to be misgendered after coming out to someone vs before. When someone is unaware of my identity, being misgendered feels uncomfortable. When I have come out to someone and still get misgendered it feels terrible. Given the high likelihood of being misgendered as a nonbinary person, this also contributes to the cost being high.

Risk

I think of the risk of coming out as the physical or safety risk. I am lucky to live in an area where being visibly queer does not inherently put me at high safety risk. I would not likely lose my job, my family support, housing, or access to medical care. So the risk of coming out for me is low.

FTM VS NONBINARY

The stage at which this coming out equation is most relevant is the time between when you come out to yourself and the time when you are fully out to everyone in your life (or as out as you ever want to be). I call this stage ‘limbo’. My husband’s limbo stage lasted about about 9 months. Mine has so far been going for about a year and a half with no end in sight.

So what makes such a huge difference? On the pro side, his need was much higher than my own. He was not at all comfortable being identified as female and it only got worse the longer it went on. His benefit was high but had much higher likelihood of paying off. On the con side, his cost was still pretty high but not as high as mine as it is generally easier for people to understand identities that fall within the binary. And, since he has a similar situation to me, his risk was fairly low. So his equation balanced in the ‘come out’ direction much faster than mine has.

SHIFTING THE EQUATION

So what shifts my equation to create those situations where it is worth it for me to come out?

The biggest one is the cost going down. If I am talking to someone who is queer or someone with previous trans knowledge, I have to do a lot less educating. In this situation the likelihood of experiencing the benefits also goes up.

The other time I am likely to come out is when my need is significantly higher (usually as a result of a triggering situation or bad dysphoria).

I will often try opening up about other ‘difficult’ topics to see what kind of response/support I get from someone as a way of testing the waters. If their interaction with me changes for the worse, my likelihood of coming out to them as nonbinary goes down significantly. So don’t take less important seeming conversations any less lightly.

Maybe some day, when the general population is more knowledgeable about nonbinary identities or if my gender shifts more consistently in the male direction, I will come out publicly. Until then, I will be paying attention to this equation situation by situation, person by person and take it one decision at a time.

Processing…

Success! You're on the list.

Whoops! There was an error and we couldn't process your subscription. Please reload the page and try again.

It’s All About Bathrooms

BATHROOMS ARE A BIG ISSUE

The bathroom debate has gotten a lot of media attention lately. Should trans people be forced to use the bathroom that relates to their sex assigned at birth or be free to use the bathroom they are most comfortable with?

I don’t want to go too much into the political debate but I can’t leave it be without making a couple key points: How exactly would this be enforced? With a DNA sample at the bathroom door? Who is this designed to protect? Because the highest risk group of people in bathrooms are trans women. And the most common offenders are cis men. In the women’s bathroom. Attacking women who are using their own bathroom.

Ok. That’s all I’ll say about that. I promise.

The reasons why bathrooms are a big issue for me are:

The physical safety risk of having to use a bathroom that I don’t appear to belong in (either men’s or women’s),
The psychological safety risk of having to misgender myself in order to use the bathroom,
Or the medical risk or choosing to avoid the first two by not using the bathroom when I really need to (which can lead to urinary tract infections, kidney infections, bladder dysfunction, or even bladder rupture).

DYSPHORIA AND BATHROOMS

Using either binary public washroom can cause trans people increased dysphoria for a number of reasons. The most obvious is by misgendering themselves in order to stay safe while using the bathroom. Then there are the mirrors, the access/lack of access to appropriate receptacles for tampons and pads, the feeling of being clocked (identified as trans by strangers) for choosing to use a stall in a men’s room when they are only peeing, and even the difference in how it sounds to pee with various types of plumbing.

Yes, trans people are going to be more sensitive to these things than the cis strangers using the bathroom with them but these are all things that run through a trans person’s head that they have to spend energy to ignore or recover from after the fact.

ALL THE DIFFERENT OPTIONS

Multi-Use Binary-Gendered Bathrooms

As an AFAB person who is not on testosterone and who has not had top surgery, I will almost never choose to use a men’s multi-use bathroom for safety reasons, no matter how masculine presenting or male I feel.

If multi-use binary bathrooms are the only option (as they usually are), I will usually choose the women’s washroom which often means I am misgendering myself in order to pee in a safe place. Some days, the impact that has on my mental health is not worth it and I will wait longer than I should to use the bathroom (see health risks discussed above).

I would love to hear what other people choose as their default, especially an AMAB non-binary person or a transwoman (please leave a comment below!)

Single-Use Binary-Gendered Bathrooms

Why do these even exist? I mean really. People who want to pee standing up can pee into a toilet just fine. People who want to sit down can ignore the urinal and use the toilet. We wouldn’t have to wait for the ‘correct’ washroom to be available and no-one would have to put themself at risk in order to use the washroom. These need to be made illegal.

Multi-Use Multi-Gendered Bathrooms

I have encountered one of these. It was an interesting experience. Coming out of a stall to see a man standing at the urinal and having him surprised to see me just as a feminine presenting woman walks in was definitely a new experience. It felt odd, mildly shocking, but mostly just interesting. And it was definitely inclusive. No one was in the way of anyone else or overtly making anyone feel uncomfortable. But I’m not sure this is the best option for the sake of protecting women from being attacked in bathrooms. I do not know enough about the stats on that to comment specifically but that is what makes me the most nervous about this option.

Single-Use Multi-Gendered Bathrooms

This is clearly the ideal. It is not very effective for saving space but definitely the most inclusive and safe. I am lucky to work in a place where this is the default type of washroom. When I see these in an airport or other public building it is fantastic. When I have to go hunting for one that I know is somewhere in the building it is less ideal but still good that it exists.

These are so optimal that I automatically keep track where the closest one that I know of is when I am out in public. If I know that a cafe across the street or a block down has these bathrooms, I will take the extra steps to use it rather than putting myself at risk by using the male or female washroom in the building I am already in.

Family/Accessibility Single-Use Bathrooms (multi-gender by default/omission)

I have a hard time allowing myself to use these washrooms. There is a lot of social stigma around a single person who appears able-bodied using a family or accessibility washroom. So of course, I have internalized that stigma. I often do not feel I have the right to use that space, even when there is no other gender inclusive option. I am trying to combat that internal voice, especially on days when I have significant dysphoria and do not have the emotional reserve to misgender myself just to use the washroom, but it is always an internal fight.

If you are someone who requires the accessible washroom, what do you think of this situation? Please leave a comment below with your thoughts.

BATHROOM MATH

As a non-binary person, I am constantly doing math to decide which bathroom to use or whether to use a bathroom at all. Things that factor into these equations are: Who is around? How badly do I have to go? When is the next time I will likely have access to a bathroom? Is there a gender inclusive bathroom close enough to make it worth the trip? What does my gender feel like? How much emotional impact will there be for me to use the women’s washroom? Do I have a friend who can go with me for safety if I would prefer the men’s washroom?

As you can see, this can be a pretty exhausting process, just to decide whether or not to go to the bathroom.

A FEW WORDS ON SIGNAGE

Why do bathrooms have to be represented by signs that indicate overtly gendered people? How does this represent a bathroom at all? Why not just a bathroom sign? And if they have to be gendered, why not a male symbol (circle with arrow) and a female symbol (circle with plus sign)? The quintessential bathroom people perpetuate gendered clothing and presentation as well as being inaccurate representations for a washroom.

Gender neutral signs that are male|female are okay but still based on binary gender and not necessarily inclusive.

While aliens, mermaids, and other mythical creatures are cute, they can feel like they are equating any gender outside the binary to being akin to being an alien or being mythical ie that it doesn’t actually exist or is not within the realm of human experiences. Clearly problematic.

‘Washroom,’ ‘All-Gender Washroom,’ or simply a toilet and/or urinal symbol would be ideal. This could include a wheelchair to represent accessibility if it is accessible (we will leave the discussion about how a wheelchair is also not inclusive signage for accessibility to another day).

Problematic Signage