Wednesday , February 14, 2018 - 3:45 PM
(c) 2018, The Washington Post.
She told doctors that she wanted to breast-feed her baby.
She explained that her partner was pregnant but was not planning to breast-feed when the child was born, so she wanted to take it on herself. The 30-year-old, who is transgender, was willing to accept the risks.
Following months of hormone therapy last year, doctors say she might be the first reported transgender woman in academic literature to breast-feed, according to a case study published last month in the peer-reviewed journal Transgender Health.
“We want to present our patients with the full range of reproductive choices and this is one step closer to that,” Tamar Reisman, who co-authored the study along with Zil Goldstein, said in a phone interview Wednesday with The Washington Post.
Reisman, an endocrinologist with the Center for Transgender Medicine and Surgery at Mount Sinai Hospital in New York, said doctors used protocols for “non-puerperal induced lactation,” in which a woman is stimulated to lactate. The patient, who had not undergone gender reassignment surgeries, was put on a hormone regimen - spironolactone to suppress testosterone, and estradiol and progesterone to mimic the hormone stage of pregnancy, according to the case study.
The patient was also given a galactagogue and told to use a breast pump to increase prolactin, a hormone that helps with milk production.
A month into her treatment plan, she was producing “droplets” of milk and, three months in, she was producing about 8 ounces of milk per day, according to the study.
The study stated that after the baby was born, the patient breast-fed for the first six weeks and, during that time, the infant’s pediatrician said “the child’s growth, feeding, and bowel habits were developmentally appropriate.”
She later supplemented feedings with formula because she was not producing enough milk, the study said.
Reisman, the study’s co-author, said that at 6 months of age, the baby was “happy, healthy and very cute.”
For a variety of reasons, the American Academy of Pediatrics recommends that babies breast-feed exclusively for the first six months - unless there is a medical reason not to - and then continue breast-feeding while supplementing with solid foods for at least a year. For mothers who cannot produce milk on their own, or for mothers who are adopting or using a surrogate, there is a protocol that includes hormones and pumping to induce lactation.
“The protocol to induce lactation is very common,” Jenny Thomas, a spokeswoman for the American Academy of Pediatrics, said Wednesday in a phone interview.
Thomas, a pediatrician and lactation consultant for Aurora Health Care in Wisconsin, said that the regimen used in the case study is similar to the one used for mothers who cannot produce milk on their own, except for the spironolactone needed to block testosterone. But spironolactone is considered “acceptable” to use during breast-feeding, according to LactMed, an online database from the National Institutes of Health’s National Library of Medicine.
“We wouldn’t expect spironolactone to get into the breast milk,” Thomas said.
But Madeline Deutsch, a doctor and associate professor at the medical school at the University of California, San Francisco, said there has not been adequate research.
Deutsch, director of clinical services at the UCSF Center of Excellence for Transgender Health, said she also is a transgender woman with a 6-month-old child. She said she can empathize with transgender mothers, but trying to induce lactation is “not something I would do,” explaining that there needs to be more research not only on whether various medications can be transferred to a fetus or an infant but also on whether breast milk produced by transgender women have the appropriate nutritional content.
“There are unknowns about the nutritional picture of the milk,” she said.
“This is not transgender women taking control of their bodies,” Deutsch added, “this is something that needs to be explored more.”
Still, when asked about the case study, Thomas, the spokeswoman for the AAP, said she believes “babies should get breast milk.”
“If one parent is unable or unwilling and the other one is, and you’re in a position to make that happen, that’s extraordinary,” she said.
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