When Trevor MacDonald started chestfeeding about five years ago, he didn't know anyone who had attempted it, nor had any of his doctors ever encountered someone who had. In fact, he was shocked that his body could even produce milk. As a trans man—someone who was assigned female at birth but has transitioned to identifying as male—he was born with the mammary glands and milk ducts required for lactation, but he'd had his breasts removed. Once he had his baby, his care providers supported his desire to nurse, but it was up to him figure out how.
MacDonald began blogging about chestfeeding from his home in Winnipeg, Manitoba, and soon discovered a whole community of transmasculine people around the world in the same boat, looking for guidance. For trans men and transmasculine folks, putting a baby to their chest to suckle can lead to complicated feelings about their gender. Many lactation support services are available for “nursing mothers,” which sounds unwelcoming to men and non-binary individuals. And many trans people say doctors don’t understand their bodies or experiences.
With no formal training as a researcher, MacDonald decided to take a scientific approach to these challenges. He teamed up with a diverse group of Canadian lactation experts, nurses, midwives, and researchers to publish “Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity,” a study that was funded by a grant from the Canadian Institute of Health Research and that recently appeared in BMC Pregnancy and Childbirth. It’s a qualitative attempt at defining the internal and external difficulties transmasculine people face when chestfeeding. There are studies about lactation and nursing, and studies about trans folks, but nothing much at the intersection of these two topics. In fact, even “chestfeeding” is the first known use of the word in the title of an academic paper.
The study recruited 22 participants who self-identified as transmasculine and who either were or had been pregnant. MacDonald and his team interviewed these participants about their experiences, and analyzed the conversations “with a goal of describing and interpreting patterns and themes that emerged,” in the study’s words. It’s an approach that’s community-based and trans-led—and the study includes explicit declarations of actions that care providers need to take to better accommodate trans folks.
Alanna Kribbe, a registered midwife out of Toronto, Ontario, and one of the study authors, explains this approach by contending that “the wisest people in a community who can speak for it are those people living in the community and with lived experience, not the person with the most degrees or years of clinical practice.”
Of the studies’ participants, 16 chestfed their babies. Nine of these chestfeeders reported no gender dysphoria—defined by the study as “the experience of distress or anxiety regarding one’s gender and body.” But two of the participants who initiated chestfeeding reported having to stop as a result of “overwhelming gender dysphoria.” Often this feeling was tied to the way the world perceived their body. One participant, whom the study refers to as Emmett, described his experience to the researchers thusly: “I was producing a ton of milk. … I didn’t have anything ready socially, either. I didn’t have any zip-up binders. I had no way to stop the milk from leaking through my chest. I had no appropriate … male clothes for nursing.”
The study also underscored the problems transmasculine people can run into when dealing with doctors and other care providers. Some participants who didn’t chestfeed their babies still struggled with mastitis and engorgement after birth, and reported that their providers weren’t prepared to deal with it, because the providers assumed their milk wouldn’t come in due to chest surgery or hormone ingestion. Other participants noted that doctors sometimes contributed to feelings of dysphoria by referring to them with female pronouns.
Based on these findings, MacDonald and his team argue in the study that there is a big need for care providers to have a better understanding of issues that affect the trans community—a conclusion that echoes the findings of one of the only other studies on this issue, “Transgender men and lactation: what nurses need to know,” published last year in The American Journal of Maternal/Child Nursing. Emily Wolfe-Roubatis, a nursing student at the University of Pennsylvania and one of this earlier study’s authors, says that a key takeaway from her research is “the very rudimentary place we’re in with being able to provide services for these folks, both in the literature and with speaking with people.”
So what can be done? Kribbe feels that one of the most important points of this research is urging care providers to be especially attentive to the terms they use. Part of that, she says, starts with the kind of education that obstetricians, midwives, and lactation counselors receive, but another part involves providers being willing to educate themselves about terminology that is gender neutral, as opposed to the gendered-female language that currently dominates lactation support. Even acknowledging that the need for change exists in the first place is an important step, the researchers contend.
In response to whether or not there were any questions about providing lactation support to transmasculine or non-binary individuals on the exam to become an International Board Certified Lactation Consultant, Sara Blair Lake, the executive director of the International Board of Lactation Consultant Examiners, offered a content outline, which shows that the gendered language “maternal” and “mother” is still common, as opposed to the neutral terminology like “parent.” Meanwhile, Melissa Cole, an Oregon-based International Board Certified Lactation Consultant, said in an email that, to her knowledge, there aren’t educational requirements for IBCLCs about how to support transmasculine folks who want to nurse their babies, and that she has received no such training. Cole, who has not yet provided lactation support to a trans person in her practice, wishes she could receive more formal education around inclusive language so she can provide better care.
Regardless of Cole’s enthusiasm, it’s hard to get a sense of the broader influence that MacDonald’s work could have on lactation research—if it has any at all—because outside of the trans community, the lactation world doesn’t seem to know quite what to do yet with chestfeeding. I emailed the Academy of Breastfeeding Medicine, the Journal for Human Lactation, and the Human Lactation Center at the University of California, Davis, in addition to several different lactation consultants, to ask about the potential impact of the new study, and all refused to comment on the grounds that the topic is outside their realm of experience. Attempts to contact the Hartmann Human Lactation Research Group went unanswered. (In 2014, La Leche League International, a nonprofit that promotes breastfeeding, did change its eligibility requirements to allow men to become volunteer breastfeeding counselors.)
MacDonald, for his part, says that he’d love to see future research on the impact of chest-masculinization surgery—the procedure in which breasts are removed and the chest is reshaped to look more masculine—on lactation and milk production. Other areas for future research include effects of testosterone on nursing, as well as whether it’s safe for someone to bind their chest (flattening the breasts with a compression garment to create a more masculine look) while chestfeeding.
MacDonald wants his research to expand the conversation around transgender identity. Often, he says, the common narrative is that people are born in the wrong body and that’s why they transition. Because of that narrative, he contends, many providers never talk to transmasculine folks about their reproductive options. In fact, the study found that zero of the participants’ surgeons discussed the potential for future chestfeeding before performing top surgery.
“The range of experiences and showing more nuance, more complexity, about transgender lives is what is most important in this study,” MacDonald says.