Induced Lactation for Trans and Intersex Women

Make Milk. No Ovaries Needed. Inducing lactation for individuals without ovaries is a topic that's not often discussed, but it's important for trans and intersex women who may be interested in this process.

If you're already taking hormones as part of your gender affirmation journey, that can serve as the baseline for your inducing lactation plan. Hormone therapy can play a key role in inducing lactation, and it's essential to work closely with your healthcare team to adjust your therapy accordingly. Approaches to hormones for trans and intersex women are generally is as follows:

• Step 1: Estrogen is increased, sometimes gradually. Progesterone is added.
• Steps 2 and 3: Estrogen is discontinued or decreased to simulate menopausal levels. Although generally discontinued in case studies found in research, my clinical experience indicates maintaining progesterone may be helpful throughout lactation.^{1,2,3.4.5,6,7,8,9,10,11}

Some parents find a low or no estrogen dose difficult to manage in Steps 2 and 3. In this case, consider increasing spironolactone, adding a phytoestrogenic herbs, or gently increasing estrogen observing for decreased milk production.^4,8

(Note: Steps 1, 2, and 3 come from The Three Step Framework for Inducing Lactation^TM.)

Spironolactone is often part of gender affirming care for trans women who have not undergone orchiectomy. Case studies do not indicate decreasing spironolactone dosing is necessary for lactation induction.^{1,2,3.4.5,6,7,8,9}

When it comes to herbs, there are customized approaches that can further support the process for trans and intersex parents.¹² It's all about working with your IBCLC experienced with lactogenic herbs to determine what works best for your specific needs.

What can parents without producing ovaries expect when inducing lactation?

In a survey of published case studies in which trans women adjusted their hormone therapy and added domperidone or metoclopramide, parents produced anywhere from 7ml/day (¼oz/day) to about 300ml/day (20oz/day).^{1,2,3.4.5,6,7,8,9} It is noteworthy in these case studies that most parents pumped no more than 6 times per day and smaller flange sizes may not have been available at the time they were expressing their milk. Pumping up to 8 times per day with flanges that fit properly may result in levels of milk production skewed to the higher end of the published results.

 Studies of parents inducing lactation with and without ovaries have shown that the composition of milk following induced lactation is comparable to that of a birthing parent, which is reassuring to know.^5,13,14

Case studies of trans women who had induced lactation reported breast changes including increased size and fullness.^5,6,7

If you have any questions or need guidance on inducing lactation, feel free to schedule a free mini consultation with me HERE. Or, if you are ready to jump right in check out my consultation packages HERE. I work with parents in person or via telehealth from wherever you are.

References

¹Elkin, B., Duran, A., Rauwerdink, K., & Goldsmith, E. S. (2024). Inducing Lactation in a Transgender Woman Without Galactagogues: A Case Report. Journal of General Internal Medicine, 1-4.

²Ikebukuro, S., Tanaka, M., Kaneko, M., Date, M., Tanaka, S., Wakabayashi, H., ... & Mizuno, K. (2024). Induced lactation in a transgender woman: case report. International Breastfeeding Journal, 19(1), 66.

³van Amesfoort, J. E., Van Mello, N. M., & van Genugten, R. (2024). Lactation induction in a transgender woman: case report and recommendations for clinical practice. International Breastfeeding Journal, 19(1), 18.

⁴Delgado, D., Stellwagen, L., McCune, S., Sejane, K., & Bode, L. (2023). Experience of induced lactation in a transgender woman: Analysis of human milk and a suggested protocol. Breastfeeding Medicine, 18(11), 888-893.

⁵Weimer, A. K. (2023). Lactation induction in a transgender woman: macronutrient analysis and patient perspectives. Journal of Human Lactation, 39(3), 488-494.

⁶Wamboldt, R., Shuster, S., & Sidhu, B. S. (2021). Lactation induction in a transgender woman wanting to breastfeed: case report. The Journal of Clinical Endocrinology & Metabolism, 106(5), e2047-e2052.

⁷Trautner, E., McCool-Myers, M., & Joyner, A. B. (2020). Knowledge and practice of induction of lactation in trans women among professionals working in trans health. International breastfeeding journal, 15, 1-5.

⁸Moravek, M. B., & Pasque, K. B. (2019, March). Lactation Can Be Successfully Induced in Transgender Women While Maintaining Gender-Congruent Serum Hormone Levels. In REPRODUCTIVE SCIENCES (Vol. 26, pp. 136A-136A). 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA: SAGE PUBLICATIONS INC.

⁹Reisman, T., & Goldstein, Z. (2018). Case report: Induced lactation in a transgender woman. Transgender health, 3(1), 24-26.

¹⁰Voon, K., & Stuckey, B. G. (2023). Induction of lactation in a patient with complete androgen insensitivity syndrome. Endocrinology, Diabetes & Metabolism Case Reports, 2023(4).

¹¹LeCain, M., Fraterrigo, G., & Drake, W. M. (2020). Induced lactation in a mother through surrogacy with complete androgen insensitivity syndrome (CAIS). Journal of Human Lactation, 36(4), 791-794.

¹²Schnell, A., and Cole, M. (2024). Exploring Pharmaceutical and Herbal Approaches to Inducing Lactation [PowerPoint slides]. virtual presentation by Luna Lactation.

 ¹³Perrin, M. T., Wilson, E., Chetwynd, E., & Fogleman, A. (2015). A pilot study on the protein composition of induced nonpuerperal human milk. Journal of Human Lactation, 31(1), 166-171.

¹⁴Kulski, J. K., & Hartmann, P. E. (1981). Changes in human milk composition during the initiation of lactation. Australian Journal of Experimental Biology and Medical Science, 59(1), 101-114.

...and if you want to dig deeper, see Published Case Reports of Lactation and/or Breastfeeding in Transfeminine People in Transfeminine Science.