Lactation and LGBTQ+ Individuals
by Anne Eglash MD, IBCLC, FABM
The Academy of Breastfeeding Medicine Clinical Protocol #33 addresses lactation care for lesbian, gay, bisexual, transgender, queer, questioning, plus individuals (LGBTQ+).
The first section of the protocol reviews the definitions of several terms used in regard to LGBTQ+ health, addressing both sexuality and gender. Assuming people are familiar with most of these terms, ‘queer’ is a word often used to generally describe individuals whose sexuality or gender identity do not fit within societal norms. ‘Queer’ is viewed as derogatory by some. ‘Plus’ is meant to acknowledge the variety of ways that individuals describe their sexuality and/or gender identity, which may not be captured among the term LGBTQ.
The authors of this protocol share some general considerations on supporting, caring for, and counseling LGBTQ+ individuals in the healthcare setting. They focus on the effects of gender transition on pregnancy and breast/chestfeeding, as well as special considerations for inducing lactation and supporting co-lactation. Co-lactation is defined as more than one parent breast/chestfeeding their child.
Pregnancy and lactation are important factors in decision-making among individuals who undergo gender-affirming treatments or surgeries, such as masculinizing or feminizing hormone therapy, orchiectomy, or removal of mammary tissue (top surgery). For example, treating children with hormones to suppress puberty, thereby preventing the emergence of their secondary sexual characteristics may have an impact on future fertility, and currently there is no research in this area. Transgender men face having to make a decision on when or whether they will have top surgery, since removing the mammary tissue will significantly impact lactation.
- Transgender men who have had their mammary tissue removed cannot lactate.
- Transgender women who are on estrogen and progesterone will not produce milk because of persistent use of estrogen.
- Inducing lactation involves developing the mammary tissue, increasing prolactin, and expressing the breasts.
- Co-lactation among 2 parents makes lactation much easier for the gestational parent, because they can share the feeding responsibilities.
- Individuals who induce lactation create colostrum similar to a gestational parent early postpartum.
See the Answer
There is not an abstract for this protocol. The protocol will be available via free access in the coming months at https://www.bfmed.org/protocols.
Gender-affirming surgery that involves removal of mammary tissue is often done in a way that leaves some mammary tissue present, allowing for glandular tissue growth during pregnancy or when inducing lactation. Mastectomies for breast cancer are done differently and involve more complete removal of mammary tissue.
Transgender women can lactate. They are often on estrogen and progesterone. The estrogen and progesterone can be increased during the initial process of inducing lactation. After several months, when expression begins, the estrogen and progesterone hormonal supplementation would be brought back down, possibly lowering the estrogen to less than the baseline dose. Individuals who engage in co-lactation to feed their child all need to maintain lactation with either frequent nursing or hand expression/pumping. They are at risk for losing their milk supplies if they don’t maintain the demand for milk with frequent expression/feeding. People who induce lactation do not experience a colostral stage to their milk. Their milk is certainly of high quality in all other ways.
This protocol is a great introduction to issues of lactation in relation to LGBTQ+ health, by providing accurate definitions, and special considerations that we should all be addressing when caring for individuals in these populations.