Violence, chest binding, and chest-related embodiment among transgender men in Brazil: a cross-sectional study from a public gender-confirming clinic

Background Transgender men often navigate gendered risks and structural constraints long before they can access chest masculinization surgery. However, the embodied implications of discrimination, physical violence, and chest binding remain underexamined, particularly in middle-income countries with universal public health systems like Brazil.Aim To examine the associations between discrimination, physical violence, current chest binding, and both chest-specific and general embodiment among transgender men receiving care in Brazil’s public health system.Methods This cross-sectional study included 90 transgender men consecutively recruited from a public gender-confirming outpatient clinic between 2023 and 2024. Participants had either undergone chest masculinization surgery or were eligible and actively awaiting it. Chest-related embodiment was assessed using the BODY-Q Chest and BODY-Q Nipple scales. General body-related attitudes were measured using the Body Investment Scale (BIS). Multivariable linear regression models with robust standard errors were adjusted for age, body mass index, educational attainment, race/color, and chest surgery status. The minimal clinically important difference (MCID) was used to contextualize the magnitude of the observed associations.Results Overall, 51.1% of the participants reported discrimination, 12.2% reported physical violence, and 32.2% reported chest binding. Current chest binding occurred exclusively among participants without prior chest surgery, representing 64.4% of this subgroup. Physical violence (β = −18.0, p = .003) and current chest binding (β = −18.6, p = .005) were associated with substantially lower BODY-Q Chest scores, with effect magnitudes exceeding the minimal clinically important difference (MCID) by more than two-fold. Discrimination was not associated with chest-specific outcomes but was associated with lower BIS scores (β = −6.3, p = .044).Conclusions Physical violence and chest binding were associated with clinically meaningful reductions in chest-related embodiment, whereas discrimination was associated with a lower general body investment. These findings underscore embodiment as a clinically relevant outcome shaped by structural adversity across the gender-confirming care continuum.