A measured look at lactation and breastfeeding by trans women

Zinnia JonesWhile public awareness of transness and visibility of trans people have grown substantially in recent years, many people are still unaware of some of the particular details of the medical process of transitioning. For instance, trans women have described occasionally encountering individuals who are wholly unaware of what our breasts are made of; these people often assume that trans women’s breasts are always created by breast augmentation surgery. In reality, hormone therapy with antiandrogens and estrogen (and sometimes progesterone or other progestins) is sufficient to produce the development of breasts – not merely the appearance of breasts, but actual breast tissue histologically identical to that seen in cis women, along with the accompanying anatomical structures (Phillips et al., 2014).

And one of the least-understood aspects of trans women’s breasts is their capacity for lactation and nursing infants.

In February of 2018, major media outlets reported on a case published in Transgender Health in which lactation was induced in a 30-year-old trans woman for the purpose of nursing her newborn (Reisman & Goldstein, 2018). Through adjustment of estrogen and progesterone levels, the addition of the lactation-promoting medication domperidone, and breastfeeding, this woman was able to experience “modest but functional lactation” and breastfeed her child exclusively for a period of six weeks, followed by supplementation with formula. The infant was observed to be healthy and developing appropriately. While this was the first case fully documented in medical literature, lactation and nursing of infants has previously been reported by several other trans women.

This case report was met with much positive-to-neutral coverage, along with a great deal of nakedly transphobic faux-concern from partisan outlets. A MercatorNet article made a point of referring to this trans woman as “a guy, with all of his sexual equipment intact”, describing her nursing her child as “a public relations stunt for the transgender movement”, and baselessly suggesting that being breastfed by a trans woman would negatively affect an infant’s IQ. A Christian Post article described domperidone as a “toxic drug” banned by the FDA, and cited anti-trans endocrinologist Quentin L. Van Meter who suggested that this medication – used widely outside the US for treating low milk supply in lactating cisgender mothers – is not “proven to be safe for ingestion” by infants.

A recent examination of these arguments in Paynter (2019) addresses many of these concerns and puts these misconceptions to rest. These include:

  • A New York Times interviewee stating “we need to make sure it is pure and hormone free” regarding this trans woman’s milk supply. As Paynter notes, “human milk is never ‘pure’ or ‘hormone free’”.
  • Concerns about the infant’s exposure to hormones. Paynter points out that the presence of female sex hormones in milk, including estrogens and progestins taken as oral contraceptives by cis women following childbirth, are not considered to pose a risk to the nursing infant: a review found “no negative effects on infant health, growth, or development, or on breastfeeding outcomes, including milk supply”.
  • Concerns about the infant’s exposure to antiandrogens. Paynter notes that there is a “low risk presented by most medication use while breastfeeding”, and that there are “only a small number of highly toxic medications that are harmful to the infant even in small doses”; the antiandrogen spironolactone, which this trans woman was taking, would only enter her milk supply “in trace amounts … unlikely to cause adverse effects”. Another cited study reported that spironolactone is “probably compatible” with breastfeeding, and that doses received by infants are “too low to be clinically relevant”.
  • Concerns about the supposed toxicity of domperidone and its impact on infants. Paynter notes that domperidone is available over the counter in several European countries, and that it is only unavailable in the US due to cardiac side effects seen in ill and elderly patients who were taking very high doses intravenously for purposes other than lactation; she further cites literature finding that domperidone is “effective in increasing milk supply with no adverse effects for infants”.

Based on these facts, Paynter concludes that characterizations of this woman’s milk as having been insufficiently “assessed” for its suitability for infants, or of her nursing her baby as some kind of unethical “experiment” being performed on children, are unwarranted. As she notes, “there is a need to resist over-medicalization and scrutiny of the human milk produced by an individual transgender person or cisgender woman whose infant shows all signs of health.” Certain outlets, often with rather conspicuous biases, may have concerns about trans women nursing infants – but it appears those concerns are not grounded in medical realities. 

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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