Breast/chest feeding and feeding of children – for trans people
Parents choose different ways of feeding their children. Emotions about body and chest feeding dictate how different people make choices around chest feeding and feeding. There are strong norms around breastfeeding. Regardless of gender identity it’s you who decide if you want to chest feed or not. If you want to try chest feeding you should get the best possible support. You can be proud and at ease, regardless of how your child is fed.
Some trans people want to give of their own milk. For others, chest feeding is unthinkable and bottle feeding with formula is a given. Some feel it’s difficult to let the child feed on the chest, but they might want to pump and feed the baby by the bottle. Others chest feed or pump some and combine with formula for a shorter or longer period of time. Some chest feed with the aid of supplemental feeding systems if their own milk is not enough. There are many ways of feeding, anything from just chest feeding to no chest feeding at all. Trans people who have not given birth may want to start their milk production and chest feed with the gestational parent or as the only chest feeder.
How norms about breast/chest feeding can affect you as a trans person
“Breastfeeding” and breasts are often connected to images of femininity and motherhood and may cause gender dysphoria in trans men and non-binary people assigned female at birth. For trans women and non-binary people assigned male at birth, the idea of chest feeding may bring gender euphoria/positive emotions. Trans women may want to breast feed as part of affirming their identity as mother. There are norms, but not everybody is affected by them. Many people have feelings and thoughts about breast/chest feeding and may have opinions about who can and should breast/chest feed. Breast/chest feeding is a personal choice, and it’s your body and your decision. Everybody who wants to try breast/chest feeding should get the best possible support.
Knowledge, exchange of experiences and support are three important key factors both before and during chest feeding. Support is especially important for trans people because of the strong norms around feeding. Try to find someone who can understand you and your thoughts and feelings about your body and feeding and who can follow you in the process. Continuity in care can be extra important so that you can feel secure and know that you’re being understood and respected and are not being misgendered or called the wrong word for parent, etc. Sometimes it takes time to find the right person, but don’t give up.
If the healthcare staff you meet during pregnancy or as a new parent need to increase their trans competency or asks you for information, tell them that they can get information from RFSL’s knowledge support Hbtq-kompetens and for those who work with people who are to become parents or are new parents especially chapter 6 about feeding and breast/chest feeding.
Do use our material Att bli och vara förälder where theme 8-9 is about breastfeeding, feeding and being a new parent. There you will find questions for reflection to use privately or with a partner, co-parents or in a group.
If you are considering masculinizing chest surgery or breast reduction as part of your gender affirming care it can be good to think about how you feel about having children later in life; if you want to carry a child and maybe breast/chest feed? It can be hard to imagine, especially if you experience gender dysphoria connected to your breasts, and that’s ok. For some it’s unthinkable to carry a child before receiving treatment for gender dysphoria.
Some are convinced they will never want to chest feed. Others know they will want to chest feed. Others are unsure or ambivalent. For some, both those who have undergone surgery and those who haven’t, thoughts and feelings that were unpredictable arise during pregnancy, and a wish to feed one’s child with breast milk arises.
A person can be satisfied with their top surgery and want to chest feed at the same time, based on the knowledge that breast milk is good for the baby or a wish to experience the closeness and bonding of chest feeding. A wish to chest feed doesn’t have to mean that you regret your surgery, but that you want to explore what options there are to chest feed after surgery. If you have had top surgery or a breast reduction and are pregnant, you can ask for information about what method was used to better understand the preconditions for chest feeding.
If you have gender dysphoria connected to your breasts and are thinking about chest feeding later in life, it can be done in different ways. Some who know they want to carry a child and chest feed later on wait to have surgery until they have stopped nursing. Others make the decision about surgery immediately, regardless of thoughts about children, because it’s necessary to get treatment. A third option is to do surgery and speak to your surgeon about using a method that increases the chance of being able to chest feed in some way afterwards.
Different surgical methods determine the chance of being able to chest feed later in life
The breast consist of (simplified) fat, connective tissue, mammary glands and milk ducts. The milk is produced in the mammary glands. From the glands, there are milk ducts that go to the nipple. The milk is transported through the milk ducts to the nipple. In masculinizing chest surgery a certain amount of mammary glands are left (all humans have mammary glands, cis men too), otherwise the chest would look sunken. In order to breastfeed the breast needs to be able to produce milk and transport it through the milk ducts to the nipple. Different surgical methods give different opportunities to chest feed. In a chest feeding preservative perspective it’s better to use methods where the nipple isn’t separated from the milk ducts during surgery. Another reason to choose this method is that it retains more sensation in the nipple.
Sometimes, conversations about pregnancy and chest feeding aren’t part of the assessment and planning of treatment for gender dysphoria. You can raise the subject with your surgeon to be able to make an informed decision. It’s reasonable to have an open conversation about fertility, giving birth and chest feeding, even for people who undergo gender affirming care, and it shouldn’t affect the possibility of accessing care. It may be valuable to discuss the pro’s and con’s with a surgeon who is an expert in the area. The surgeon needs to choose a method based on several aspects, for example how large the breast is, and an individual assessment needs to be made based on your situation, wishes and your body.
Testosterone treatment affects the breasts and reduces the amount of fatty tissue in the breast. The mammary gland tissue becomes denser and harder, which makes the breasts smaller and tighter. Trans people are recommended to have been on testosterone for at least six months before having top surgery, to improve the outcome of the surgery. This is also the time frame for when your hormone treatment can affect your ability to chest feed. Testosterone might affects the ability to produce milk negatively, not much research has been done in the area. Testosterone can’t be used while chest feeding, as we currently don’t know how it affects the infant. You can resume your testosterone treatment immediately after ceasing to chest feed.
Many years of binding can affect the breast tissue negatively, but it doesn’t necessarily mean it’s hard to chest feed. You are recommended not to use binding during a period of chest feeding since it can affect milk production negatively and increase the risk of engorgement. There are examples of gentle binding that has worked. In those cases chest feeding and milk production has been established and binding only used during parts of the day. It’s your body and your decision. Be gentle and attentive to signs of engorgement, which are pain, reddening, swelling and fever.
Pregnancy’s effect on the breast tissue
Before a pregnancy you need to stop testosterone treatment as testosterone is toxic to the fetus. When pregnancy starts, the breast tissue are affected by pregnancy hormones. Both mammary glands and milk ducts grow during pregnancy and the breasts are physiologically prepared for breastfeeding. Sometimes milk ducts can grow back to the nipple. The number of milk ducts varies between people and are usually between four and 18.
Pregnancy changes can reduce the effect of testosterone treatment on the breast tissue. The growth of the breasts may trigger gender dysphoria, but at the same time can be perceived as neutral, positive or purposeful if you are thinking about chest feeding.
Regardless of if you’ve had surgery or not, and regardless of if you’re planning to chest feed, you can ask your midwife for information and support about how the breast tissue will change and react during pregnancy and after delivery. We are different, and one cannot say for sure how your breast tissue will react. Many trans people attest that regardless of how the changes during pregnancy feel, it’s easier to prepare emotionally if you are prepared for what can happen.
Breastfeeding after top surgery
You can always try to chest feed, even after surgery. Some people who have undergone masculinizing top surgery have been able to produce a surprising amount of milk, while others have only produced a few drops and some none at all. Remember that even a smaller amount is valuable to the baby, and that you can chest feed with formula through a supplementary feeding system during the whole chest feeding period.
You can never tell beforehand if you will have a sufficient milk production and/or functioning chest feeding. You have to try and see. All breast surgery can affect future chest feeding, even breast reductions and breast enhancements that cis women do.
After you have given birth, there are significant hormonal changes in your body that give your mammary glands signals to start producing milk. The best thing for the baby is to be skin to skin with you to get warmth and feel closeness. This closeness also helps chest feeding. If the baby lies skin to skin with you by your chest, it will, within one to two hours, move towards the breast and want to chest feed. The midwife at delivery can help you and the baby so that the baby gets a good hold. It can be a bit harder for the baby to latch on, because the tissue and skin isn’t that flexible, but that can be remedied through chest feeding support. Try to get support from an experienced professional and try different ways and angles to find out what works. There is something called the “hamburger latch method”, which means that you squeeze the breast tissue like a hamburger to help the baby latch on. Sometimes it can help to use a feeding teat, which is an aid to make sure the baby opens its mouth wide before latching on.
If you decide not to chest feed
The best thing for the baby is to lie skin to skin with you to get warmth and feel closeness. The baby will look for the breast, but you can keep the baby skin to skin and instead feed it formula through a cup or bottle. The midwife at delivery can show you how to cup feed, and the staff at the postnatal ward will help you learn how to bottle feed. You don’t have to bring your own bottles to the hospital. Read RFSL’s text with information about bottle feeding at the website.
Immediately after the delivery you can start using a tight sport’s bra or something similar. Supporting the chest helps with possible pain and makes the body understand it shouldn’t produce milk. Wait with binding as this increases the risk of engorgement and pain. Everybody who gives birth, even those who have had top surgery or mastectomy, can start producing milk because of the hormones after delivery. You may get a swollen chest/swollen breast tissue, it may feel tight or throb. Milk might leak out of the nipple. If there is milk that doesn’t come out there’s a small risk of engorgement. But you may not have any reaction at all. It’s important to know that this is temporary and will pass. Milk is produced based on supply and demand. If no milk is expressed, the body will stop producing milk. It’s not a problem if you have to express a smaller amount of milk because the breast is very tight, but express as little as possible, for example through dipping the breast into a bowl with warm water or gently push along the breast while taking a warm shower. Ask the midwife at the postnatal ward for advice and support. You should check your chest the week after delivery and contact care if you experience a lot of pain, sudden swelling or lumps or fever, as this can be a sign of engorgement.
In some cases, it’s possible to get medication to stop milk production after delivery. The medication has side effects that may worsen mental ill health, and is therefore not for everybody. If you feel that you would be helped by such medication, you can ask a doctor about it during pregnancy, either at the midwife’s, at the labour ward or your doctor in psychiatry.
Gender dysphoria and chest feeding
For a person with gender dysphoria there’s a risk that chest feeding can lead to increased anxiety. Chest feeding can, however, despite gender dysphoria, be experienced as positive and that the breasts have gotten a purpose and function. Only you know how you feel, and it’s your decision to choose to, or not to, chest feed. Many factors govern if your chest feeding is working, it can also be about the baby or that there isn’t enough support, etc.
One scenario is that you feel a certain or strong unease about chest feeding, but that you still feel an inner pressure to do it as it’s described as the best thing for the baby and that every parent wants to give their child “the best”. You might chest feed, but at the cost of strong or increased anxiety, or even having the need to dissociate with your body during chest feeding. Here you need support in thinking about what’s best for you and the baby, preferably with trans competent care staff. There’s not much research about attachment and mental ill health regarding trans people and chest feeding.
Here are some statements to reflect upon:
- To experience closeness during feeding could be more important to parent and child than that the child gets breast milk.
- “The best” for a child is a parent that feels as good as possible, which in some cases means choosing not to chest feed.
- If anxiety and dysphoria arise when the child is nursing you can pump milk and give it in a bottle instead.
- There are many ways of chest feeding between chest feeding exclusively and no chest feeding at all, and maybe you can find a solution that works for you. Even a small amount of breast milk is valuable to your child.
- You may chest feed for a shorter time than the recommended six months, and you can reconsider your decision whenever you want.
- You can be proud and satisfied as a parent no matter how your child is fed.
Trans women’s possibilities of breastfeeding
All humans are born with mammary glands, milk ducts and nipples. All humans can, thus, in theory, produce milk. This is governed mainly by hormones, but also the amount of mammary glands and milk ducts. There are stories about trans women who both have breastfed and started producing milk. One trans woman breastfed exclusively for six weeks and partially breastfed when the baby was six months. In those cases milk producing promoting medications have been combined with the hormone treatment that has been part of the person’s gender affirming care. Your ability to breastfeed will also depend on how many years you’ve been on hormones before breastfeeding, as a lengthy estrogen treatment gives a growth and development of mammary glands and milk ducts. If you’ve had breast surgery with implants the risks of breastfeeding complications are the same as for everybody who’s had that type of surgery. In Sweden there’s very little information about if medication is accessible and what knowledge doctors have in supporting that kind of induced breastfeeding. This will hopefully become more common in the future. If you are non-binary and assigned male at birth and are not undergoing medical treatment you probably have pretty low preconditions to start milk production, but that doesn’t mean you can’t try to breastfeed. Regardless of the possibilities of getting functioning or bigger milk production it’s possible to breastfeed for closeness and comfort and with the help of a supplemental feeding system as long as the child is interested in it.
If you want to read about breastfeeding without milk production, co-nursing and starting milk production, you can read Guide to co-nursing and induced breastfeeding at rfsl.se.
Stories about trans women’s possibilities to breastfeed
- Case Report: Induced Lactation in a Transgender Woman https://www.liebertpub.com/doi/full/10.1089/trgh.2017.0044
- Yes, Trans Women Can Breastfeed — Here’s How:
Here are links to more information and support.
CHEST FEEDING SUPPORT FOR TRANS PEOPLE
- Trevor MacDonald from Canada is a key actor who has worked a lot with support to trans people who want to breastfeed. He has written a book in 2016: Where’s the mother? Stories from a Transgender Dad
- Scientific research article: MacDonald, Trevor, 2016, “Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity: a qualitative study”. https://bmcpregnancychildbirth.biomedcentral.com/…/s128…
- Milkjunkies: Breastfeeding and parenting from a transgender perspective: http://www.milkjunkies.net/
- Transgender parents and chest/breastfeeding • KellyMom.com
- La Leche League (LLL) is an international, nonprofit, nonsectarian organisation. LLL supports everyone who wants to breastfeed or chestfeed in reaching their goals. Support for transgender and non-binary parents: https://www.llli.org/brea…/transgender-non-binary-parents/
- My journey: Non-binary Breastfeeding (blogginlägg): https://lllusa.org/my-journey-non-binary-breastfeeding/
- The Lactation network: Breastfeeding FAQ for Trans and Non-Binary Parents: https://lactationnetwork.com/blog/breastfeeding-faq-for-trans-and-non-binary-parents/
Closed Facebook groups
- LLL LGBTIQA+ Families Welcome to La Leche League LLL LGBTIQA+ Families: a safe space for families who identify somewhere across the sexuality and gender identity rainbow.
- Birthing and Breast or Chestfeeding Trans People and Allies This group is intended for sharing information and experiences about pregnancy, birth and breastfeeding amongst trans and genderfluid/gender neutral people anywhere on the gender spectrum, at any point in transition (or pre-transition).
- Trans Feminine Breastfeeding and Lactation Support. Please ask to join the ‘Trans Feminine Breastfeeding and Lactation Support’ group from within the ‘Birthing and Breast or Chestfeeding Parents and Allies’ group.
For healthcare staff looking for knowledge about breastfeeding ans trans:
- The chapter Amning och matning in RFSL’s knowledge support Hbtq-kompetens – för dig som arbetar med blivande och nyblivna föräldrar at rfsl.se. There’s also a reference list of the existing scientific articles on breastfeeding and LGBTQ.
- Diana West is IBCLC (International Board Certified Lactation Consultant) and answers common questions from care staff about trans people’s breastfeeding: https://dianawest.com/trans-breastfeeding-faq/
- Three summarising “tips sheets” about how to best support trans people, specifically about trans men and breastfeeding and specifically about trans women and breastfeeding: https://www.lllc.ca/sites/default/files/REVISED-Trans-Breastfeeding_Tip-Sheet.pdf
- BFAR: Breastfeeding After Reduction. Website with information about the possibility of breastfeeding and support to be able to breastfeed after different kinds of breast surgery. https://www.bfar.org/