If you ask any breastfeeding parent why they breastfeed, they will tell you that they have a
myriad of reasons to breastfeed. Those who are not in a breastfeeding relationship may assume
that the purpose is purely for the proven and well-known health benefits of breastmilk to a baby.
It’s true, huge health benefits are conveyed to babies when they are breastfed. These benefits
include a decreased risk of the following: allergies; cancer; obesity; type 1 diabetes; infection of
the ear, respiratory, or gastrointestinal tract; sudden infant death syndrome; and necrotizing
enterocolitis specific to the preterm baby. Less known health benefits are those imparted to the
mother when she breastfeeds, including decreased risks of high blood pressure, cancer of the
breast or ovaries, type 2 diabetes, anemia, and postpartum depression. Many who have
breastfed acknowledge that breastfeeding has positively affected their experience of parenting.
Emotional benefits include increased calm and confidence of the mother, greater closeness and
bonding, and increased stress reduction in both parent and child. The value of the positive
emotional impact breastfeeding has on mother and child cannot be diminished. Oxytocin has
been proven to have a positive impact on both the mother’s and the child’s affects individually
and in relationship with one another.
Emotional satisfaction is an easier criteria to meet than physical benchmarks of breastfeeding
“success,” such as a specific amount of weight gain in the baby. A healthy breastfeeding
relationship can be possible even despite physical breastfeeding challenges being present.
Breastfeeding is not simply a mechanism of getting milk into a baby; it is a holistic experience
for the parent and child where bonding is solidified and, often, life sustaining nutrition is
transferred. Breastfeeding is frequently synonymous with high volumes of milk transferred.
However, if we expand the definition of breastfeeding beyond milk transfer, we can acknowledge
the reality that babies are soothed by sucking at the chest and an important interaction occurs
whether or not milk is transferred.
Chestfeeding is defined as feeding your baby from your chest. Chestfeeding is often used when
the term breastfeeding is not preferred, or when the parent does not identify their chest with
having breasts. The term is often used in place of the word breastfeeding in families or
situations where a breast does not feel like an appropriate term for an individual’s body.
Although the mechanism of a baby nursing from a chest might appear the same as someone
who is breastfeeding, the difference is in the terminology with which a parent most closely
identifies. Closeness and bonding between infant and parent can still be met regardless of the
quantity of milk transfer. In cisgender and especially transgender nursing relationships, quantity
of milk produced can be a concern as it can be impacted by insufficient glandular tissue or
hormones (levels of estrogen, testosterone, prolactin, etc). However, regardless of amount of
milk transferred or how the act is referenced, chest or breastfeeding may continue and convey
beneficial impact on parent and child.
Breast/chest feeding in LGBTQIA+ families
As we have come to understand a wider breadth of how we identify ourselves as humans,
parents who identify as transgender-male (persons assigned at birth as female but identify as
male) or transgender-female (persons assigned at birth as male but identify as female) may
wish and seek support to breastfeed. There are as many ways to have breastfeeding fit a family
as there are family structures. For instance, in adoptive families, one or both parents may
induce lactation.
Transgender-males may choose to undergo hormone therapy and top surgery to create a more
masculine appearance. Testosterone is occasionally taken to suppress breast growth and milk
production 2. Top surgery is defined as when the breast tissue has been surgically removed to
allow for a more typical male chest appearance; milk production will subsequently be impacted.
Often when a transgender-male breastfeeds, it is referenced as chestfeeding, out of parental
preference for how their body parts are identified. Hormones like testosterone, taken to
encourage a male appearance, may counter hormones like estrogen and prolactin, which are
necessary for breastfeeding. If the transgender-male gave birth, there will be a greater likelihood
of milk production naturally occurring postpartum. Some transgender-males can experience
dissatisfaction with the childbearing process and can experience a resultant anxiety called
gender dysphoria.
A transgender-female may take estrogen prior to lactation. Depending on the length of time
hormones are taken, varying amounts of glandular tissue may develop as a result. If breast
implant surgery has been performed, this may damage the breast ducts, nerves, and tissues
and impact the ability to create a full milk production.
Several case reports have been recorded where transgender women have been able to provide
an adequate supply of breastmilk for their baby. In the 2018 case report from Reitman &
Goldstein, years of hormone therapy with spironolactone, estradiol, progesterone, and
domperidone and regular use of a breast pump allowed full milk supply to be achieved 2.
Estrogen, of which estradiol is a synthetic form, is believed to grow mammary tissue. Some
parents choose to share breast/chestfeeding with their partner, often the birth mother. Induced
lactation protocols or use of galactagogues are also helpful in producing mammary tissue and
creating milk production.
Alternatively, some parents choose to try dry nursing, where a baby
latches but does not transfer milk, which allows for closeness and bonding to be the priority.
There is a great amount of variability in expected milk production in a transgender-male or
female, with a full milk supply, drops only, or no milk at all being possible. Depending on if the
baby prefers a fast milk flow, breast/chestfeeding may still take place even in the instance of
very low milk production. In many cases the breast/chestfeeding relationship can still be
preserved using an at-breast supplementer where baby can latch and drink breastmilk through a
tube at the breast or chest.
A discussion of whether or not breast/chestfeeding is desired should be had with all postpartum
parents, but particularly in a transgender family, as different viewpoints of their body functions in
accordance with their chosen identity may be common.
Facebook groups such as Birthing and Breast or Chestfeeding Trans People and Allies, can be
helpful to lend support to families who wish to breast/chestfeed or who are breast/chestfeeding
and identify as transgender. Lastly, milk sharing sites such as Human Milk 4 Human Babies or
Eats on Feets are wonderful sources for human milk.
Contributed by Danielle Chu, RN, BSN, IBCLC