“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 with Zil Goldstein, said in a phone interview late 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, started 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 also took a galactagogue and was 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 that “the child’s growth, feeding, and bowel habits were developmentally appropriate.”
The patient later supplemented the breast-feedings with formula because she was not producing enough milk, according to the study.
Reisman 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 other 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 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.
However, the patient was also taking domperidone, an anti-nausea and vomiting medication that is used off-label as a galactagogue to help increase milk production.
Domperidone has not been approved for sale in the United States and the Food and Drug Administration has previously warned women against using it, saying there are “serious risks” associated with the drug, including cardiac arrhythmias, cardiac arrest and death.
The transgender patient acquired it from Canada, according to the case study.
Madeline Deutsch, a doctor and associate professor at the University of California at San Francisco's medical school, said she has serious concerns because there has not been adequate research on transgender women and breast-feeding.
Deutsch, director of clinical services at the UCSF Center of Excellence for Transgender Health, said she is a transgender woman with a 6-month-old child. She said that she can empathize with transgender mothers that but trying to induce lactation is “not something I would do,” saying that there needs to be more research not only on whether medications can be transferred to a fetus or an infant but also on whether breast milk produced by transgender women has 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 that 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.
This story has been updated.