Lactation Induction in a Transgender Woman: Macronutrient Analysis and Patient Perspectives

Abstract

Introduction Induction of lactation in a non-gestational parent has numerous potential benefits including parent–child bonding, optimal nutrition, and health benefits to the child and breast- or chest-feeding parent. For transgender women and nonbinary people on estrogen-based, gender-affirming hormone therapy, the ability to nourish their infants through production of their own milk may also be a profoundly gender-affirming experience. Two prior case studies have been published describing induced lactation in transgender women, but analysis of the nutritional quality of the milk produced has not been previously described. Main issue Here we describe the experience of a transgender woman who underwent successful induction of lactation in order to breastfeed her infant, who was gestated by her partner. Management Through modification of exogenous hormone therapy, use of domperidone as a galactogogue, breast pumping, and ultimately direct breastfeeding, the participant was able to co-feed her infant for the first 4 months of life. We provide a detailed description and timeline of the medications used, laboratory and electrocardiographic measurements, results of the participant’s milk analysis showing robust macronutrient content, and description of the participant’s experience in her own words. Conclusion These findings provide reassurance about the adequacy of nutrition from human milk produced by non-gestational transgender female and nonbinary parents on estrogen-based, gender-affirming hormone therapy, and support the importance of this experience on a personal level.

Lactation induction in a transgender woman: case report and recommendations for clinical practice

“…This case endorses that lactation induction protocols are also successful in transgender women. Our study is in line with published case reports, in which lactation induction was successful, but the production of milk was not sufficient for exclusive nursing [ 4 , 5 , 11 ]. Nevertheless, as the success of induced lactation is often attributed to parent-infant bonding, rather than the possibility of exclusive chestfeeding, this experience is valuable [ 25 – 27 ].…”

“…Literature and protocols on lactation induction is scarce and merely based on case reports in cisgender women [ 6 – 10 ]. Research focussed on induction of lactation in transgender women is lacking and to our knowledge, only three case reports on lactation induction in transgender women have previously been published [ 4 , 5 , 11 ]. However, transgender women chestfeeding is not limited to these case reports.…”

Safety of pharmacologically induced lactation

“…The current pharmaceutical regimen for induced lactation often includes hormonal therapy with a combination of estrogen and progestin. [6][7][8][9][10][11][12][13][14] The purpose of hormonal treatment is to mimic the effects of these hormones during pregnancy and thereby prepare the mammary tissue for breastfeeding. However, there are no randomized controlled trials evaluating the effect of combination oral contraceptives on induced lactation.…”

“…18,19 The evidence supporting the effect of domperidone on inducing lactation in nonpuerperal women is based on 11 individual case reports. [8][9][10][11][12][13][14][20][21][22][23] The cases include induced lactation in adoptive mothers, 8,9,20,21 intended mothers of surrogacy, 10,22 lesbian couples wanting to co-lactate, 11,12 and transgender women wishing to breastfeed. 13,14,23 The daily dosage of domperidone administered in the case reports was between 60 and 80 mg.…”

“…[8][9][10][11][12][13][14][20][21][22][23] The cases include induced lactation in adoptive mothers, 8,9,20,21 intended mothers of surrogacy, 10,22 lesbian couples wanting to co-lactate, 11,12 and transgender women wishing to breastfeed. 13,14,23 The daily dosage of domperidone administered in the case reports was between 60 and 80 mg. The outcomes were generally positive, as all individuals achieved some degree of lactation.…”