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.