Inducing Lactation: A How-To
Here at Trans Fertility Co., we wrote our first article about inducing lactation in January of 2021. In that article, we shared that data on lactation for trans women was limited to anecdotal stories, and we weren’t able to share specific details on exact protocol for inducing lactation. That’s mostly still true, over a year later, but there is now at least one case study looking at an instance of successful lactation induction in a transgender woman of 30.
So what does the case study tell us?
A lot!
The study authors share the exact hormones levels of this transgender mother, which is great news for other trans women who want to pursue breastfeeding. You should be able to request blood work from your provider that pulls similar parameters, utilizing those metrics in partnership with a provider to determine whether a hormonal regimen similar to that described in the study may work for you.
The providers who wrote this study explain that they used specific hormones to mimic the process of pregnancy in the patient, in the hopes of inspiring the body to produce milk. Here’s what they did:
(1) Increased estradiol and progesterone dosing to mimic high levels seen during pregnancy. The patient took these hormones orally, in increasing doses throughout her partner’s pregnancy, with the goal of producing enough milk to nourish her infant upon birth.
(2) Use of a galactogogue, or medication that increases the body’s ability to produce milk. The study describes off-label use of domperidone, a medication that the patient obtained in Canada. The patient used increasing levels of domperidone throughout the lactation induction process, but the study authors share that they aren’t convinced that the medication was necessary for achieving the patient’s lactation goals. Further, it can pose a financial and logistical challenge for patient to obtain medications across national borders, and many patients may be hesitant to use medication not approved by the FDA for their intended purpose.
(3) Daily use of a breast pump in the hopes of increasing prolactin (lactation hormones) and oxytocin (a brain chemical known to cause feelings of love and relaxation) levels. The study authors believe that this step was perhaps most critical in the lactation induction process. She began using the breast pump for only ten minutes per day, increasing usage throughout the process until she was using the pump up to six times daily.
(4) Subsequent reduction in estradiol and progesterone levels, with the intention of mimicking delivery. Once the patient was producing 8 oz of milk per day, which occurred three months after starting treatment (and two weeks before her infant’s due date), her estradiol and progesterone intake was reduced drastically, and she was able to exclusively breastfeed for the first six weeks of her child’s life.
(5) Continued spironolactone regimen while breastfeeding, for androgen blockade. This is the one step that is unique to transgender women when inducing lactation. The patient referenced in this study was already taking spironolactone as hormone replacement therapy, and continued to do so in order to reduce her body’s production of androgen (which would prevent the production of human milk).
There is still so much more to learn about transgender women’s fertility and lactation possibilities. But this case study is an exciting advancement in the field of trans fertility, and we laud its authors, Tamar Reisman and Zil Goldstein, for their work with this patient and in the field of trans health!
