Nonmedical Gender-Affirming Practices in Transgender and Gender Diverse Adolescents: A Narrative Review

Purpose: Transgender and gender diverse (TGD) adolescents may experience distress with chest and genital anatomy as a result of incongruence between their gender identity and their assigned sex. Nonmedical gender affirmation practices (chest binding or padding/genital tucking or packing) are reversible and temporary gender-affirming practices that may help alleviate the distress before, or in addition to, medical or surgical treatment. Although these nonmedical gender-affirming practices can provide mental health benefits, they may also have long-term physical side effects. This review aims to summarize available data on the risks and benefits of nonmedical gender-affirming practices in TGD adolescents.Methods: A narrative literature search of major databases was conducted. Given the paucity of studies on TGD adolescents, data from studies conducted on TGD adults were included to outline an overall picture of the younger population.Results: A total of 17 articles and four online resources were included in this review. Nonmedical gender-affirming practices have a strong positive impact on the mental health of TGD youth. When binding and tucking are performed conscientiously, both practices are generally safe. Pediatricians and other involved health providers should discuss with the youth the main risks associated with binding (back pain, overheating, skin irritations, and chest compression) and tucking (itching, skin irritations, infections, and testicular torsion) while providing advice on how to minimize them.Conclusions: Nonmedical gender-affirming practices can relieve mental suffering caused by gender incongruence. Adolescents, families, and health care professionals should improve their knowledge of the risks and benefits of these practices. Due to lack of data on nonmedical gender-affirming practices in pediatrics, our findings confirm the urgent need for dedicated research on nonmedical gender-affirming practices among TGD adolescents.