LAURA JESSUP, OREGON, USA
Breastfeeding–the ability to feed a child the perfect and ideal food at the breast—is this necessarily feminine?
A transman gives birth. A transwoman, chromosomally XY, induces lactation. A parent identified as female at birth has a condition called androgen insensitivity syndrome, so is genetically male but appears female. What does it mean to be a woman? Is gender even binary? If not, this spectrum of sexual orientations and gender identities creates implications for breastfeeding.
Questioning these assumptions about gender also asks that we deconstruct our understanding of motherhood, as well as our definition of breastfeeding. Is breastfeeding only associated with women? What is breastfeeding? Parents who produce little or no milk, but who latch the baby to the nipple and comfort the baby at the breast, are they “breastfeeding”?
Here we are, families and caregivers, and a spectrum of gender identities. You, I, my brother, my grandfather—we all have mammary tissue that can produce milk—albeit tiny amounts if there is no hormonal stimulation for milk production. But even drops of human milk contain essential nutrients and immune protection.
Early medical writers such as Aristotle and the Corpus Hippocraticum reported male lactation. In contemporary literature, we see male lactation in Louise Erdrich’s The Antelope Wife, a novel in which a solitary soldier cares for an abandoned infant by putting the baby to his chest. He begins by rubbing animal fat on his nipple to make it more comfortable when the baby sucks ravenously. Eventually, the soldier begins to produce milk. An interviewer asks Erdrich about the scene,
“A man nursing a baby in The Antelope Wife?”
Erdrich replies, “What’s strange about that? There are several documented cases of male lactation. It’s sometimes uncomfortable for me to read that scene in front of mixed audiences. Men get upset. But I think it’s a great idea. It would solve about half of the world’s problems.” In the novel, the baby grows strong and healthy. Even tiny amounts of milk from the man provide some nutrition and significant immune support.
During the Triassic period more than 200 million years ago, breast tissue evolved from modified sweat or sebaceous glands. It is an ancient reproductive feature, pre-dating placental mammals. These ancient reproductive features produced a nutrient-rich milk-like secretion and evolved in both females and males.
Males of some species spontaneously lactate. The male Dayak fruit bat is a mammal that routinely lactates, but many mammals, such as male goats and neutered cats are often observed lactating, especially when around newborns.
In the mid-1900s a drug called Thorazine was used as an antipsychotic. It affected the pituitary gland by causing it to overproduce prolactin and subsequently induced lactation. When used in men to improve gastric motility, prolactin enhancing drugs such as metoclopramide and domperidone can also result in lactation, as can the heart medication, digoxin.
Men have been observed to lactate under extreme stress, after castration, when ingesting phytoestrogens, or as a result of pituitary tumors or other prolactin disruptions in the pituitary gland. Some authorities claim that nipple stimulation may be enough to induce lactation in men. Others argue that men must first experience a hormone shift. Without the growth of glandular breast tissue during puberty and pregnancy, men who begin lactating will likely produce only tiny amounts of milk.
Starvation stimulates prolactin release, which accounts for male lactation occurring in war camps. Perhaps men hold this ability to lactate as a way of comforting children during times of famine and severe crisis. Evolutionary biologists speculate that lactation in both male and female parents has adaptive value.
How can we support parents who wish to breastfeed? Milk production is initiated by the cascade of hormones triggered by birth, but parents who do not give birth can induce lactation to make some milk.
Milk production can be encouraged by effective latches, breast compression, frequent feedings at the breast, pumping, hand expression and plenty of skin-to-skin contact. Milk production can be augmented by pharmacologic and herbal galactagogues. When there is minimal or low milk production, parents can use a supplemental feeding system to offer milk through a small tube at the nipple. In this way, the baby receives milk at a parent’s chest which stimulates the milk supply at the same time.
A recently published case study reports that a transgender woman, who had been receiving feminizing hormone therapy for six years, successfully induced lactation. After one month of treatment to induce lactation, she expressed droplets of milk. After three months of treatment, she expressed each day eight ounces of milk, enough to exclusively feed her adopted newborn for six weeks. This study appears to be the first report published in medical literature of an individual, identified as male at birth, who successfully induced lactation to provide significant amounts of milk for her child.
For a transgender man, the process of lactating may cause distress—an unsettling tension between identity as male and association with feminine breastfeeding. He may be eager to resume testosterone therapy, but he may also feel pressure or a desire to provide his milk for the baby. For parents who have had top surgery, there may be limited mammary tissue, and the amount of milk production will depend on the type of surgery and the condition of the ducts and nerves involved in lactation. These parents may prefer the more gender-neutral term “chestfeeding.”
Even drops of nonpuerperal human milk have significant levels of protective proteins such as secretory IgA, lactoferrin and lysozyme, and just the act of sucking at the breast improves facial development compared to bottle feeding. Parents know that human milk is good for the baby, but lactation is good for parents, too. Lactation involves the release of relaxation hormones such as prolactin and oxytocin, resulting in lower stress for both the baby and the parent. If breastfeeding were more broadly accepted as a human “art”—ungendered and biologically possible for all–perhaps more parents would feel at ease comforting their babies at their breast.
As we support all families who make milk for their babies, we can be mindful of gender inclusive language. Open-ended questions such as “what pronoun do you prefer” and “what term for feeding the baby do you prefer?” allow for welcome communication. In the spirit of inclusion, equity, and diversity, make no assumptions about gender identity in the art of breastfeeding.
Capuco, A. and Akers, M. (2009). The origin and evolution of lactation. Journal of Biology, 8(4), 37.
Farrow, A. (2015). Lactation support and the LGBTQI community. Journal of Human Lactation, 31(1), 26-28.
Halliday, L. (2010, Winter). Interview with L. Erdrich. The Paris Review, 195. Retrieved from http://www.theparisreview.org/interviews/6055/the-art-of-fiction-no-208-louise-erdrich
Kunz, T. (2009). Male lactation: why, why not and is it care? Trends in Ecology and Evolution. 24(2).
Reisman, T., & Goldstein, Z. (2018). Case Report: Induced Lactation in a Transgender Woman. Transgender Health, 3(1), 24-26.
Sperling, J. (Ed.) (2013). Medieval and Renaissance Lactations: Images, Rhetorics, Practices. Burlington, VT: Ashgate Publishing Company.
Swaminathan, N. (2007). Strange but true: males can lactate. Scientific American, 6, 558-63.
Wilson, E, Perrin, M., Fogleman, A., & Chetwynd, E. (2015) The intricacies of induced lactation for same-sex mothers of an adopted child. Journal of Human Lactation. 31(1) 64-67.
Laura Jessup – “My profession is teaching writing; one of my passions is helping families breastfeed. For 15 years I’ve volunteered as a La Leche League Leader, and am an active member of Southern Oregon Lactation Association.”