Can Transwomen Breastfeed?
I come from Eastern Europe and asking this question over there will probably get you a lecture on gay propaganda and rotten Western values. So instead I decided to search Twitter for some answers, and, predictably, found a shitstorm brewing. People were calling transwomen pedos, transwomen were calling them pedos in return and saying they are just projecting, people were calling it unnatural or completely natural, and a few journalists were probably making some sweet dollars from the whole thing. There were a few sane-sounding people in the mix, but hey who wants to listen to those?
Unfortunately, I don't have some people's ability to detect whether someone is a pedo over the Internet, so I'll try to do the second best thing, and look at the literature. Our journey starts with a bit of fiction. Apparently, in Anna Karenina, there is this scene of a baby suckling on a man for sustenance.1 Not sure what that means but I thought I'd put it here to sound more well-read. Moving on to some more serious reads, there is a book from 1896 called Anomalies and Curiosities of Medicine2 which cites some more interesting cases. It describes a few cases of men breastfeeding their children after their wives were unable to do so (due to sickness or death). There is even a mention of "a whole Indian nation whose women had small withered breasts and whose children owed their nourishment entirely to the males". Keep in mind this book was written before the turn of the 20th century when one of the main hobbies of the rich was going psychic seances and talking to the spirits. Conversely, one of the main hobbies of the not-so-rich was scamming the rich out of their money with wild stories.
With this out of the way, let's move to modern times and to the question at hand: Can transwomen - men who have done HRT (Hormonal Replacement Therapy) to transition to women - produce breastmilk and feed their children. The answer is actually yes. There have been a few documented cases of transwomen producing enough milk to at least partially breastfeed a baby3. These are case studies, not actual controlled trials so it is unclear what such results mean for the general population of transwomen. We simply don't know if that is something possible for everyone or just select isolated cases.
But how is this at all possible? The fact that even a couple of transwomen were able to produce breastmilk is mind-blowing in itself. And it turns out it's not even that complex of a procedure. It turns out to be a process developed initially to help biological women induce lactation, in such cases as when they adopt a baby, have to nurse someone else's baby, or just give birth to a baby but don't start lactating on their own.
Back in 2002, a woman called Lenore Goldfarb had a baby via a surrogate. Since her body didn't go through a pregnancy, the hormones that would normally induce lactation were not there and she was unable to produce breastmilk. In order to breastfeed her baby she developed a protocol that induces lactation4, based on information found in Jack Newman's book “Dr. Jack Newman’s Guide to Breastfeeding”. This protocol became known as the Goldfarb-Newman Protocol and has since been used to help hundreds of women to induce lactation. There is a Herzl-Goldfarb breastfeeding Clinic in Canada, which utilizes this exact protocol. Jack Newman and Lenore Goldfarb are the Chairman and President respectively, of an organization called the Canadian Breastfeeding Foundation
The full Newman-Goldfarb protocol is designed specifically for women who will not give birth to the babies they want to breastfeed. This is most often because they are adopting or are having a baby via gestation. The protocol takes 6-9 months and the reasoning behind is that during pregnancy a woman's body changes in order to prepare her breasts for lactation. This is due to increased levels of hormones like progesterone, estrogen and prolactin. Once the baby is born, progesterone and estrogen levels drop and prolactin levels increase, which results in the production of breastmilk. The Goldfarb protocol aims to mimic these changes via a combination of an active birth control pill and a drug called Domperidone. The birth control pill induces developments in the breasts while countering the lactation-inducing effects of Domperidone. Then, 6 weeks before the baby is expected to arrive, the woman stops taking the birth-control pill while continuing to take the Domperidone. Over the next few weeks, the woman should pump her breasts for 5-7 minutes every 3 hours and also do some massaging.
It turns out, that this protocol not only works for biological women, it is effective in inducing lactation in transwomen as well.5 Is this dangerous for the woman or the baby she is breastfeeding? The birth control pill delivers estrogen and progesterone - hormones that are produced in much bigger quantities during pregnancy, so there seems to be little risk associated with that.
What about the Domperidone? This seems to be one of the central points of most critiques I've seen against transwomen breastfeeding. The drug might enter the baby's system through the milk and then have some horrible side effects on the child. Do these claims hold? Domperidone used to have FDA approval in the US, but that approval was withdrawn and a warning was issued6, citing increased risk of "cardiac arrhythmias, cardiac arrest, and sudden death in patients receiving an intravenous form of domperidone". These are all effects seen in the women breastfeeding, not the babies. On top of that these effects are likely to occur in older women taking the drug.7 Still, even young mothers with a history of cardiac problems or arrhythmias are advised against using Domperidone to induce lactation. There are some other nasty side effects, for the woman, including dry mouth, headache, dizziness, nausea, abdominal cramping, diarrhea, palpitations malaise, and shortness of breath. Stopping the drug cold turkey, instead of weaning off comes with its own host of problems, including insomnia, anxiety, and tachycardia.
Sounds like a nasty experience overall, although not one which is life-threatening, unless you are in the risk group. What about the baby, though? Sure, a woman is free to take her own risks, but are there any risks for the baby? First of all, it seems like an insignificant amount of Domperidone enters the baby's system through the breastmilk.8 Canada seems to be the main place where Domperidone is used to induce lactation. Four different studies, looking at a total of ~1200 women using Domperidone, reported no adverse effects in the infants related to the drug.9 One study followed a transgender woman who breastfed her infant for 6 months and found no abnormalities in the infant's growth, development and bowel habits.
Does this mean Domperidone is safe? These are definitely some good results. I would like to see more research done, with numbers bigger than a thousand, just in case there are some ultra-rare side effects caused by the minute amounts of Domperidone that do make it to the infant. With this said, there doesn't seem to be an obvious danger to the infant associated with the drug. Also, if the critique against transwomen breastfeeding is centred around Domperidone being dangerous, does this mean the drug should not be prescribed to biological women either? After all, they form the vast majority of mothers taking it to induce lactation.
Before we get to the good part - is the milk any good - there is one point I need to address. If you just give a man birth control pills and Domperidone for 9 months, they still probably won't be able to produce any adequate amount of breast milk. While the glands and the piping are there, breast tissue also needs to be developed in order for the whole system to work for milk to come out. Transwomen take a cocktail of hormones as part of their transition, in a process called Hormone Replacement Therapy. The three main types usually taken are estrogen (to increase female), anti-androgens (to block male hormones) and progesterone.
Here the literature is lacking, to say the least. For Estradiol, the most common estrogen used in HRT, there are 2 studies, looking at a total of 7 breastfed infants whose mothers received estradiol. One of the studies warns of a possible relationship between Estradiol and poor weight gain in the child10. The other study, looking at 6 infants found no problems.11 For Spironolactone, one of the two most commonly prescribed antiandrogens, there are just four case studies. They all found no adverse effects on the children's health.12 The other common antiandrogen is Cyproterone Acetate and I couldn't find any studies looking at the effects it has on infants' health. It is known to pass to the breastmilk in small quantities13. Lastly, we have Progesterone, which seems to be the only one in the group that has received any extensive testing. There are a number of studies, looking at hundreds of cases, and they find no adverse effects on the growth or weight gain of infants.14
I am not a massive fan of this. With the exception of Progesterone, I can count the safety studies on the fingers of one hand. This is a far way from proving that it's safe to breastfeed a child while taking any of these drugs. If you are a transwoman and decide to do it anyway, it's extremely important that you get advice from a doctor who can provide adequate monitoring of your baby throughout the process. The lack of any research into the long-term effects of these drugs on infants’ health should not be overlooked either.
So what about the milk?
If you have been paying attention so far you can probably predict this next sentence. The literature here is extremely limited. As in 2 relevant case studies which actually test the nutrient content. One is of a man with a condition called Galactorrhea (abnormal production of milk) and the other is of a transwoman who used Domperidone to induce lactation.15 In both cases, the actual nutrients were comparable to those of biological women. In the case of the transgender woman, she was able to produce up to 150ml of milk per day. Another study, which unfortunately doesn't look at the nutritional make-up of the milk, reports a transwoman who was able to exclusively feed her baby via breastfeeding for the first 6 weeks of its life.16 This means around 0.5 - 0.8 litres of milk per day.17 Since you can't store breastmilk for more than 4-5 days18, she must have actually produced that much milk. Hence, it seems reasonable to assume that some transwomen are able to produce enough milk to feed a baby, or at least provide supplementation so that not all the nutrition comes from a formula. Again, it is not clear if this is true for all transwomen, and to what extent
Here is the place to talk about baby formula. When thinking about transwomen breastfeeding one might be prone to compare the situation to biological women breastfeeding (e.g. the baby should be fed by a biological woman instead of a transwoman). However, in some cases, this is not possible - if the baby was born by a surrogate mother, or if the baby's biological mother is unable or unwilling to breastfeed it. In that case, the alternative is baby formula. Most often made from cow milk, it can act as a vital source of proteins, fats and oligosaccharides for the infant. However, this is not without its downsides.
Providing nutrition for the infant is not the only role that breastfeeding serves. It also provides them with a boost to their immunity system, possibly by transferring immune cells from the mother to the infant.19 This doesn't happen for babies who are fed solely with baby formula from the moment they are born. There is literature showing that babies fed with baby formula only are at a higher risk of developing respiratory tract infections, diabetes and obesity20 (it's worth mentioning that one study found no difference in risk of respiratory infection between breastfed and formula fed babies21). Does the milk of transgender women offer the same boost to the baby's immune system? I see no reason why it wouldn't, but once again, the research just isn't there. Is it more risky to feed a baby solely formula than it is to breastfeed it as a transgender woman? I don't know, it seems like the immunity thing is a big bonus for breastfeeding. On the other hand, given how lacking the research around HRT and breastfeeding is, there might be other risks involved that we just don't know about yet.
Of course, like a lot of other conversations online, this one is politically charged. Trying to find information about the issue feels like walking through a shit tornado, with people shouting insults at each other from all directions, citing shitty articles, and engaging more with the psychology of the opposition than with any scientific findings. There are a few voices of reason willing to actually discuss the data we do have, but those are few and far between. Needless to say, it seems unlikely that all transwomen wanting to breastfeed babies are paedophiles. It also seems unlikely that every single person criticizing them is just projecting and is therefore a paedophile.
Another thing I find concerning is the amount of people who have their opinions about the safety of this set in stone. This is despite the fact that pretty much all the literature we have on the issue is cited in the article you just read. That's how little we actually know about it. Yet, I've heard everything from how this will kill babies or have long-lasting negative effects on their health, to how there is virtually no chance that something bad will ever happen. We simply don't know enough to back either of those opinions. The truth might be somewhere in the middle, as it often is, and maybe one day we will have enough research to tell. Until then the shouting match goes on.
Found in this article