Tips for Transgender Breastfeeders and Their Lactation Educators (2024)

This information is free for personal use. Any trans folk are welcome to print it out and give a copy to their health care provider! However, if you wish to publish any part of it or quote this material in a presentation you must obtain formal permission. Thanks!

I'm not a health care professional and this blog entry does not constitute or replace medical advice. Please consult your doctor if you need medical advice.

**** This blog post has been updated and now comes in three parts: 1) general information 2) assisting trans men 3) assisting trans women

Transgender/transsexual/genderfluidTip Sheet – General Information

Preparedby Trevor MacDonald

This tipsheet provides some key details you should be aware of when offeringreproductive/lactation support to transgender, transsexual, or genderfluid individuals.Keep in mind that in most ways, medically and otherwise, trans people are justlike everyone else. There is a list of key terms and their definitions at theend of this sheet.

Gender vs. Sex

Ourreproductive organs and sexual anatomy define our physical sex – male, female, or intersex. Gender, however, is a person's inner awareness of their femininity/masculinity. Gender expression has todo with how an individual presents their gender to others within a givencultural context. For example, within western culture the colour pink has gonefrom being a traditional boys' colour to one for girls in only a fewgenerations.

In mostcases, a person’s biological sex conforms totheir gender and gender expression. The term for such people is cisgender.Transgender, transsexual, and genderfluid people have a gender identity orgender expression that does not match what their particular society expects ofthem according to their anatomy. Some trans people choose to use medicaltherapies such as hormone treatments and/or surgeries to alter their bodies.Others do not want or are unable to obtain such interventions, but may expresstheir gender in other ways such as choices of clothing or makeup.

Gender Identity vs Sexual Orientation

Aperson's gender identity has to do with how they self-identify. Their sexualorientation refers to what kind of person they are sexually attracted to. Aperson can be trans and gay, or trans and straight, or trans and bisexual, etc.

Asking Questions

It may beessential to ask questions regarding an individual's gender identity or historyof medical transition in order to provide adequate care. However, only askthose questions that are relevant. Do notask questions solely out of curiosity.

Language

Alwaysuse the pronouns that refer to an individual's expressed gender, not theirassigned birth sex. For example, a male-to-female transsexual woman is 'she'.If you are unsure of which pronouns a particular individual may prefer, simplyask in a respectful manner. If you make a mistake, apologize promptly and moveon. Some people prefer gender-neutral pronouns, such as 'them' and 'they' or'ze' and 'zir'.

Thefollowing terms are derogatory. Do notuse: tranny, he-she, she-male, gender-bender, or transvestite.

Do not refer to someone 'masquerading','pretending', 'disguising', etc. in their gender.

Usetransgender as an adjective, not a noun or verb.

He is a transgender person, not "He is atransgender." (similar to how it is best tosay "He is a black person", rather than "He is ablack")

A person is transgender, nottransgendered. It is never necessaryto add the suffix 'ed' to transgender.

Common terms

*Notethat these definitions explain how the following terms are generallyunderstood. However, individuals within the trans community may define themdifferently or may self-identify outside of these labels.

cisgender: someone whose gender identity matches their assignedbirth sex (they are not transgender)

FtM:female-to-male trans person

MtF:male-to-female trans person

gender binary: The notion that there are two genders, male and female.Many trans people understand gender as a spectrum.

gender expression: a person's outward presentation of their gender throughphysical traits, clothing, makeup, etc.

genderfluid/genderqueer: someone who identifies between or beyond the extremes offemale and male on the gender spectrum, or who identifies as both female andmale at once or as some combination of genders.

gender identity: a person's inner sense of their gender.

intersex:a condition in which an individual is born with reproductive and/or sexualanatomy that does not fit the usual male or female definition.

trans:an umbrella term meant to include transgender, transsexual and genderfluidpeople

transgender: a person whose gender identity or expression does notmatch the typical societal expectations of their birth-assigned gender.Transgender people may or may not wish to modify their bodies to varyingdegrees by taking hormones or having surgery.

transition: a change in one's publicgender identity (one's inner gender identity may have been the same sincebirth).

transsexual: a person whose gender identity does not match their sexas it was assigned at birth. Transsexual people usually wish to modify theirbodies in order to alleviate this incongruence.

Tipsheet for assisting trans men

Trans menare individuals who were born with anatomy typical of females but identify onthe masculine side of the gender spectrum. Some choose to give birth and/ornurse their babies, and may require lactation support.

Language

Althoughboth men and women have breast tissue, the word 'breast' is most oftenassociated with women. Trans men may be more comfortable referring to their'chest' and 'chestfeeding' or 'nursing' their infants, rather than'breastfeeding'. Trans men may refer to themselves as 'dad', 'papa', or anotherterm, rather than 'mom'. Don't makeassumptions. Remember that if you are unsure, it is best to ask about whichnames and pronouns an individual prefers to be used. If you make a mistake,apologize promptly and move on.

Testosterone Use

Many, butnot all, trans men choose to take testosterone. Testosterone normally causesthe cessation of menstruation and ovulation, and brings about male secondarysex characteristics such as deepening of the voice, growth of facial hair, andmale pattern baldness.

When atrans man stops taking testosterone, his cycles are likely to return afterseveral weeks or months, depending on how long he took the medication and hisown physical particularities. However, most of his male secondary sexcharacteristics will remain. For example, once testosterone has stimulated thegrowth of hair follicles in a person's face, those follicles will stay thereand hair will keep growing unless extensive electrolysis treatments areundertaken (a common element of male-to-female individuals' transitions).

Althoughvery rare, some trans men have been known to become pregnant accidentally whiletaking testosterone. Testosterone is highly toxic to the fetus and should neverbe used during pregnancy. However, because the body metabolizes and clearstestosterone rapidly, it is considered safe to conceive within a few months ofdiscontinuing most forms of testosterone therapy.

Testosteroneuse during the period of lactation would likely interfere with the hormonesrequired to produce milk and achieve let-down.

Top Surgery

Sometrans men choose to have male chest-contouring surgery, also known as 'topsurgery'. This is different from a mastectomy (a cancer treatment), or a breastreduction, which is performed to make a smaller but still female chest. Thegoal of top surgery is to create a male-appearing chest. In order to do thissome, but not all, of the client'smammary tissue is removed. Complete removal of the mammary tissue would resultin a sunken chest shape.

Thepreferred surgical technique for top surgery is variable, depending on factorssuch as volume of tissue and skin elasticity of the client. The 'doubleincision' technique usually involves nipple grafts, and is not ideal formaintaining nipple sensation nor preserving milk ducts. The 'peri-areolar'approach, with incisions that go around the outer borders of the areolae,leaves the nipple stalks intact and likely has better results in terms offuture breastfeeding and milk production.

Binding

A trans man who has not had top surgery may choose to bind hischest in order to flatten it, thereby managing his gender dysphoria. Many yearsof binding may adversely affect the glandular tissue. Binding during theimmediate postpartum period will increase the risk of blocked ducts andmastitis and may damage the milk supply. However, some individuals have hadsuccess with occasional, careful binding once the milk supply is wellestablished and regulated. Anyone who practices binding during the lactationperiod should be advised of the risks of doing so, and should monitor thehealth of their chest closely.

Chestfeeding Goals

Sometrans men who give birth do not want to chestfeed at all, in some cases forreasons to do with mental health. Others do, and opt to postpone desired topsurgery so that they will be able to produce a full milk supply. Others whohave had top surgery may still wish to develop a nursing relationship and maydo so using an at-chest (at-breast) supplementer.

Gender Dysphoria and Chestfeeding

Genderdysphoria occurs when an individual feels discomfort due to parts of their bodythat do not match their gender identity. Growth (or re-growth after topsurgery) of chest tissue during pregnancy may bring up extreme feelings ofgender dysphoria in some individuals, possibly causing anxiety or evendepression. Chestfeeding can do the same. For this reason, deciding tochestfeed is a very personal choice.

Supporting the Decision NOT to Nurse

Support an individual who has chosen not to chestfeed by sharinghow he can quickly reduce his milk supply after the birth. Explain the supplyand demand system that governs lactation. Encourage the client to remove onlyas much milk as necessary to feel relatively comfortable, since removing moremilk will cause the body to increase production. Cold compresses and coldcabbage leaves may help reduce pain and swelling. The parent should NOT bind atthis time due to the increased risk of pain, blocked ducts, and mastitis. Severalherbs such as sage, peppermint, and parsley are said to decrease milk supply.

Discuss the many other ways of bonding with baby, such as bed-sharing,babywearing, and loving, attentive feeding. You may wish to let the client knowabout the possibility of obtaining human milk through milk sharing sites suchas Human Milk 4 Human Babies or Eats on Feets.

Supporting the Decision TO Nurse

Berespectful when providing ‘hand-on’ care. As in most health care situations, ask permissionbefore touching an individual's body, explaining what you are planning to doand why. If an individual is not comfortable being touched, find other ways tohelp, such as demonstrating on yourself.

Watch forsigns of postpartum depression. Trans individuals may be particularly at riskdue to struggling with gender dysphoria in addition to the usual challenges ofgiving birth and caring for a newborn.

Whenassisting those who wish to chestfeed after a previous top surgery, it isessential to remember that nursing a baby is not only about the milk. Anindividual who has had surgery may produce a surprising amount of milk, or onlydrops, or nothing at all. Any amount of milk is valuable. By using asupplementer, the parent and baby can gain the benefit of bonding through anursing relationship even in the absence of milk production. In addition, the action of nursing helps promote thenormal development of the jaws and teeth in the infant.

Latchingmay be challenging for the parent who has had previous top surgery due to arelative lack of pliable tissue and skin. The parent may need to learn how tovigorously mould the chest tissue (make a 'sandwich'). When providingassistance, be creative and expect to try many different grasps from varyingangles in order to find what works.

Areclining position may unfortunately cause the chest tissue to become even moretaut and difficult to latch to. In this case, football hold or cross cradle maybe easier.

Support Meetings

Encouragethe trans breastfeeding parent to attend group meetings and ensure that a safeand positive environment is provided. We know that peer support is an importantpredictor of a parent's success achieving their personal breastfeeding goals.Trans parents may already feel isolated, especially if they do not know otherLGBT families. Group meetings can be tremendously beneficial.

Thosefacilitating the meeting should know the location of a men's washroom or genderneutral washroom near the meeting room. They should use gender-neutral languagesuch as "breastfeeding parent" instead of "mother" whenaddressing the group.

Other Support and Resources

Thecommunity of trans individuals interested in birth and various infant feedingmethods is growing fast. At this time, the only online support group is theFacebook-based Birthing and Breastfeeding Transmen and Allies, with over 500members worldwide. The group includes many interested and supportive lactationconsultants and LLL Leaders.

Toronto'sLGBT Parenting Network runs a weekend course once every few years fortransmasculine individuals considering pregnancy.

Diana West's book, Defining Your Own Success: Breastfeeding After Reduction Surgery, contains information relevant to trans men who have had top surgery. Also see her web site, bfar.org.

Tipsheet for assisting trans women

Transwomen are individuals who were born with anatomy typical of males but identifyon the feminine side of the gender spectrum. Some trans women may wish tobreastfeed their children via induced lactation and/or using a supplementer.

Inducing Lactation

Transwomen may induce lactation by following the Newman-Goldfarb protocol. Aphysician would need to prescribe the appropriate medications. Birth controlpills should be started about six months before the baby is expected or as soonas possible. Domperidone is also suggested in the protocol. 6-8 weeks beforethe birth, the birth control pills should be stopped, and the woman shouldbegin pumping frequently to stimulate glandular tissue and to remove milk. Thedomperidone is normally continued for the duration of the lactation period.

A transwoman should discuss with a physician, such as a reproductive endocrinologist,what kind of hormone treatment is best to take during lactation. Unfortunately,there has been little to no research done in this area. Some trans women havesuccessfully taken a decreased dose of their usual estrogen while lactating.Any medications, such as anti-androgens or estrogens, should be carefullyconsidered for safety during lactation on an individual basis.

Expectations

Sometrans women have induced lactation with impressive results, providing nearly afull supply to their babies. The amount of milk that is produced will dependsomewhat on how many years the women used hormones prior to inducing lactation,and how fully her glandular tissue developed during that time. If the woman hadimplant surgery, she may encounter some difficulty with severed ducts, damagednerves, compressed glandular tissue, and/or scarring.

As is thecase with chestfeeding trans men, the amount of milk that is produced is not asimportant as the nursing relationship itself. An at-breast supplementer may beused to support a nursing relationship.

Support Meetings

Encouragethe trans breastfeeding parent to attend group meetings and ensure a safe andpositive environment is provided. We know that peer support is an importantpredictor of a parent's success achieving their personal breastfeeding goals.Trans parents may already feel isolated, especially if they do not know otherLGBT families. Group meetings can be tremendously beneficial.

Resources and Further Information

Diana West's book, Defining Your Own Success: Breastfeeding After Reduction Surgery, contains information relevant to trans women who have had breast surgery. Also see her web site, bfar.org.