A version of this piece originally appeared on Assigned.
People are getting really worked up about the fact that trans women can breastfeed their kids. In late June, Mika Minio-Paluello, who works on climate policy, spoke about water shortages in the UK for a TV segment. In a b-roll shot, she rinsed out a breast pump. It didn’t take long for users of Mumsnet, a parenting forum notorious for hosting extreme anti-trans views, to theorize that the pump was a prop planted so that Minio-Paluello—a trans woman who has a child—could pretend she was a regular mother.
Mere days after this, Fox News brought the breastfeeding controversy over to the U.S. with a story that dug up a few sentences from the Centers for Disease Control and Prevention’s website referencing breastfeeding in the trans community. While the CDC guidance seems aimed primarily at supporting trans men and trans mascs who give birth after top surgery, it was presented by Fox as evidence that the CDC supports breastfeeding by trans women. This frame was subsequently picked up by the New York Post, the Daily Caller, and many more.
As with many similar small controversies, a frenzy of activity among right-wing writers and anti-trans activists commenced, with each trying to one–up the other’s performative disgust over trans women’s bodies. To which I say: Maybe they should calm down their feelings and consider the biology here. The science behind lactation is neat!
We usually think of a mom breastfeeding a baby that she personally gave birth to, but that conception is a little limited. In parts of Africa, re-lactation (that’s induced lactation for a woman who has previously breastfed) is a common cultural practice that has been leveraged to feed children of women with HIV or AIDS. Folklore, particularly in the Muslim world, contains many stories of women who breastfed children other than their own, including tales of virgins doing so without ever having given birth. There are also rare reports from around the globe, bordering on folk tales, of cis men breastfeeding children.
Not that it can’t actually happen. In Western medicine, hormonal conditions resulting in cis male lactation are well known, and the understanding of how both breast growth and lactation can be produced in cis men using hormones goes back at least as far as this study from 1954. Although the literature on this is mixed, at least one study has suggested that the composition of such milk is within the normal range of more typically produced human breast milk.
This milk production can be just secretions, though. When it comes to producing enough milk to be a food source for a child, something called the Newman-Goldfarb Protocols for Induced Lactation comes into play. The protocol starts with the use of hormonal birth control, which is known to work by mimicking the hormonal balance found in pregnancy, preventing new pregnancies from starting. After several months of a pregnancylike hormone balance, patients abruptly stop taking the birth control to mimic the hormonal change of giving birth. The Newman-Goldfarb protocol then has patients start an anti-nausea medication called domperidone, which is known to increase levels of prolactin—the hormone that triggers milk production.
Patients, including cis men, who take domperidone are known to have lactation (galactorrhea) as one potential side effect. While it’s not the only medication known to increase prolactin, it’s considered one of the safest. Although it’s possible to induce lactation simply by stimulating the breasts with pumping or with a child’s latching on, domperidone seems to increase the amount of milk produced (according to Drs. Newman and Goldfarb), bringing it closer to the amount needed to nourish a child. Even so, many women (both trans and cis) who follow the protocols find they need to supplement their milk production a bit to keep their baby fed.
The use of domperidone comes with concerns about a rare but serious side effect, specifically an increased risk of heart failure for at least some patients. While the drug is widely used in Europe, Canada, and Australia, including being sold over the counter in many countries, the FDA has not approved it in the U.S. due to these concerns. (It is generally believed that only trace amounts of the drug would be transferred to a breastfeeding infant, but this has not been established conclusively as yet.)
Cis moms have used the Newman-Goldfarb protocols to breastfeed adopted infants and children born through surrogacy for years, and there have been several news articles covering the practice. (Although domperidone can’t be prescribed for this purpose in the States, some U.S. women obtain it from Canada or elsewhere for the purpose.) In a dozen stories about adopted, surrogate, or same-sex moms using hormone therapy—articles that ran as early as 2011 and as recently as this past April—not a single one I read editorialized against the practice. Mentions of potential risks were muted, with the focus being the emotional reactions of cis women who felt they benefited greatly from having the chance to nurse their kids. The 2011 piece ran in the Daily Mail with the headline “How Adoptive Mothers Are Learning to breastfeed Their New Babies” and featured a gauzy pink photo of a woman breastfeeding her child. The piece emphasized the experience of bonding that breastfeeding allowed adoptive moms.
That kind of coverage stands in stark contrast to the recent meltdowns over trans women feeding their kids. A Daily Mail article that ran on July 5 warned in the very first sentence that trans women are “self-indulgent” and “selfish,” according to an unnamed source concerned that the Newman-Goldfarb protocol—which is what the cis moms also use—may pose a health risk to babies. (According to a National Library of Medicine database updated in May: “No adverse effects have been found in a limited number of published cases of breastfed infants whose mothers were taking domperidone.”)
The most overheated corners of the conservative internet quickly sexualized the issue, insisting that trans women who induce lactation aren’t doing it to bond with their babies or help their partners, but must instead have more nefarious motives … because they’re trans. Several conservatives simultaneously insisted that breast milk that comes from a trans woman can’t possibly be milk. This over-the-top concern implies that trans women are incapable of assessing the basic reality on the ground as they parent their kids. Further, a case report published in May 2023 in the Journal of Human Lactation analyzed the macronutrients of a trans woman’s milk, finding that it was indeed adequately nutritious.
More research, and perhaps general monitoring of the outcomes, for both trans and cis women who breastfeed kids using the Newman-Goldfarb protocol seems desirable. (Trans women are demonized for choosing to mother in ways that include potential risks; cis women are often expected to perform certain actions and roles, any potential risks that they may personally be uncomfortable taking on be damned.) But it would be a stretch to imagine that induced lactation presents any significant public health concern, or even wild deviation from the inventive ways human beings have thought about milk over the years. The current meltdown over trans women breastfeeding is based not on science but a fear that science is being implemented to help and benefit the wrong people.
Update, July 18, 2023: This article was updated to more accurately characterize the forum Mumsnet.