Proof ‘chestfeeding’ is no replacement for breast? 37-year-old trans woman who wanted to ‘bond’ with baby had to give up after two weeks because she wasn’t producing enough milk

A trans woman who tried ‘chestfeeding’ had to give up after a fortnight, according to a case report that challenges claims biological men can breastfeed successfully. 

The unidentified 37-year-old, from the Netherlands, failed to produce enough liquid to feed her newborn. She was making only 7ml a day, 100 times less than what the NHS says is needed by that point.

Medics in Amsterdam, who treated her, documented how she wanted to breastfeed in tandem with her partner to help with ‘bonding’ and share the workload. 

The trans woman – who froze her sperm before transitioning – conceived her child with her partner, a biological female, via IVF in 2020 using her own sperm.

Despite months of preparation, she had to stop the ‘exhausting’ process two weeks after her child was born due to the low amount of milk produced.  

But the researchers still said ‘chestfeeding’ – a controversial gender-neutral term for breastfeeding – was still ‘valuable’ for their patient. Sharing the trans woman’s case, they also said breastfeeding has ‘outgrown’ its traditional female roots.

Trans women breastfeeding is a controversial topic.

Last month an NHS trust was forced to defend itself after stating ‘human milk’ from trans women is as good for babies as that produced by biological women. 

And last year a British trans woman sparked outrage after sharing a photo of her breastfeeding her child on a bus.

Induced lactation in trans women is not only controversial in itself.

Experts are also concerned by how little we know of the long-term impacts of the process on children, given how some of the medications and hormones taken by trans women to induce lactation can leak into milk produced. 

Writing in the International Breastfeeding Journal, the Dutch researchers said there was a ‘rising demand’ for chestfeeding among trans women.

They detailed the case of their 37-year-old patient who was being treated for gender dysphoria in Amsterdam. 

The trans women in question had undergone hormone therapy for 13 years and had a vaginoplasty, the removal of male genitalia and creation of an artificial neo-vagina. 

Doctors prescribed her hormones and a galactagogue, a substance which induces lactation, for six months to help her lactate.

She also used a breast pump to physically prepare her body for milk extraction. 

This process is known as the Newman-Goldfarb protocol, and is designed to mimic the changes a woman’s body undergoes during pregnancy to prepare her for breastfeeding. 

Once the baby was born, the medics reported the trans woman had some initial success in chestfeeding, giving her a ‘positive experience’.

‘Our patient started lactating and although the production of milk was low, it was sufficient for supplementary feeding and a positive experience for our patient,’ they wrote. 

However, she was forced to stop after just two weeks, describing the process of pumping for milk as ‘exhausting’.  

The medics also said the infant had suckling problems due to a developmental issue, and the trans woman was producing a low amount of milk. 

At her peak, she produced just 7ml of milk per day, about 1 per cent of what a biological woman should ideally produce two weeks after birth.

The NHS says by two weeks, new mothers should be producing between 500 and 700ml of milk in a 24-hour period. 

While the medics said chestfeeding may help trans women with feelings of gender dysphoria, they said this wasn’t the case with their patient.  

‘Our patient reported that lactation induction did not have a significant effect on her gender identity, neither did it alter the amount of gender dysphoria experienced,’ they wrote.

They added that the trans woman said she was ‘happy’ to have achieved lactation, and for her child to latch onto her breast and ‘be comforted’.

She said the decision to stop chestfeeding had been ‘tough’ and ‘it was a pity’ not to be able to continue in the longer term. 

The medics wrote the trans woman started breastfeeding earlier than planned with the baby born at 38 weeks instead of the expected 40, which may have impacted her success. 

Cases recorded previously in medical literature have had similar outcomes, where the amount of milk produced is insufficient for feeding. 

However, the authors said the process still had value for the parent.  

‘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,’ they wrote. 

But independent experts have previously expressed concerns about the practice. 

One of those concerns is how the galactagogues used a part of inducing lactation could be dangerous to children. 

Domperidone, primarily used as an anti-nausea medication, is one of the most commonly used in this process due to having a lower risk of side effects. 

While not expressly designed for inducing lactation the drug — branded as Motilium — ups levels of prolactin, the hormone which encourages the production of milk, effectively tricking the body into making milk. 

However, it still carries a potential risk of causing problems with a baby’s heartrate, as tiny amounts have been detected in breastmilk among women taking it, something the medics in the recent case study acknowledged. 

The patient leaflet for Motilium warns breastfeeding mothers that its ‘best not to take’ it while nursing a baby due to the potential safety risks.

‘Small amounts have been detected in breastmilk,’ it reads.

‘Motilium may cause unwanted side effects affecting the heart in a breastfed baby.

‘Motilium should be used during breast feeding only if your physician considers this clearly necessary.’

Exactly how much domperidone passes through breast milk is still being assessed.

But the NHS advises that it is generally only a ‘tiny amount’ and has been used by women for many years without causing side effects in babies.

However, it still warns that it is best for breastfeeding women to only take it for a short time, and to keep a close watch on their baby for any changes in behaviour that could indicate a potential problem.

The drug is banned in the US entirely over concerns it causes heart problems. 

Domperidone is not officially approved in the UK for use in trans women wanting to breastfeed.

But, medics are still allowed to prescribe it to increase milk production ‘off-label’ — a technical designation when a drug is being provided outside of its intended use. 

Another known risk of the practice is that the medications trans women are prescribed as part of their gender affirming care could leak into the breastmilk they produce.

One of these is called spironolactone, a drug designed to stop the male hormone testosterone from working.

The Dutch medics said there is a potential risk of the drug passing into ‘human milk’ and it could impact the development of genitalia in newborn boys as a result. 

They said this potential risk should be communicated to patients. 

Another concern regards the nutritional composition of the ‘milk’ produced by breastfeeding trans woman.

The medics said they didn’t analyse the nutritional value of the milk produced by their patient and this remained an area that needed further research overall.

Previous studies analysing milk produced by trans women are limited to a few isolated cases due to the rarity of the practice, meaning not much is known in general.

Limited work done so far suggests trans women produce milk resembling that of ‘mature’ breastmilk that produced towards the later stages of breastfeeding when the baby is older.  

‘Mature’ breastmilk lacks colostrum, also called ‘liquid gold’, a component of breast milk produced in late pregnancy, and shortly after birth, which is highly nutritious to a newborn. 

It gets its name from its yellow hue and the fact that it is packed with protein, vitamins, and antibodies that protect the baby from infection.

The the Newman-Goldfarb protocol used by trans women to lactate was originally developed in 2000 for women who had adopted a baby or had a child via surrogacy and still wanted to breastfeed.