A medical team from Mount Sinai in New York City is the first to formally report on the details of an experimental therapy that allowed a transgender woman to exclusively breastfeed her newborn baby for six weeks.
Image: Ozgur Poyrazoglu/Flickr
Over the years, trans women have used various do-it-yourself treatments to induce lactation, with mixed results and only anecdotal reports of success. A new technique developed by Tamar Reisman and Zil Goldstein at Mount Sinai's Center for Transgender Medicine and Surgery marks "the first time medical professionals have worked towards the same goal and published their results in a medical journal," according to a press release. The details of the case report can now be found in the journal Transgender Health.
The three-and-a-half month treatment involved the use of hormones, a nausea drug and a breast pump to stimulate milk production. The mother was able to produce about 227g of milk a day, which is below average but enough to sustain a newborn. She was able to exclusively breastfeed her baby for six weeks, after which time she supplemented with formula.
"This is such exciting news for all transpeople, as well as adoptive parents and parents of children born with the use of a surrogate," Anne Weeks, a certified lactation consultant working in Hamilton, Ontario, told me. "The human body is incredibly adaptable and milk production is a very robust system. However, there is so much more to breastfeeding than producing milk. Every parent with the desire to nurture their child at their breast, or chest, can experience enhanced infant-caregiver bonding and attachment, with long-term positive effects on health, social, physical and intellectual development, regardless of the amount of milk produced."
The 30-year-old trans woman approached the Mount Sinai medical team saying her partner was pregnant but had no interest in breastfeeding - a role she was happy to take on in her place. The patient had been taking feminising hormone treatments for the past six years to develop fully grown breasts (Tanner stage v, according to the standard sexual maturity rating) using spironolactone, progesterone, and a type of estrogen. She hadn't received gender-affirming surgeries such as breast augmentation, orchiectomy (removal of testicles) or vaginoplasty.
The woman's treatment began at the end of her partner's second trimester and involved four different elements, namely the use of hormones to mimic the high levels seen during pregnancy, the off-label use of an anti-nausea drug called domperidone, breast stimulation, and the subsequent reduction in hormones to simulate childbirth.
The patient had to obtain domperidone from Canada, as it isn't available in the United States. This drug is known to increase prolactin levels (a hormone that stimulates milk production after childbirth) and milk volume, but the US Food and Drug Administration says it's dangerous, warning of associated health risks such as cardiac arrhythmias, cardiac arrest and sudden death - but only when used intravenously. And because the effects of domperidone have never been tested on newborns, the FDA warns against its use as a means to induce breastmilk. However, domperidone is used widely in Canada to boost milk production among breastfeeding mothers.
"Domperidone has been safely used in Canada as a medication to increase milk supply for decades," explained Weeks. "The concern around this medication revolves around research showing possible heart-related side-effects; however, patients in the study had an average age of over 70, the drug was administered intravenously, and many had other health conditions. As of 2015, Health Canada has not received any reports of serious heart-related adverse effects in anyone of childbearing age taking domperidone.
Here's how things went after the baby was born, as detailed in the case report:
Three and a half months after she had started the mentioned regimen, the baby was born weighing 6 lbs 13 oz [3kg]. The patient breastfed exclusively for 6 weeks. During that time the child's pediatrician reported that the child's growth, feeding, and bowel habits were developmentally appropriate. At 6 weeks, the patient began supplementing breastfeedings with 4 - 8 oz [118-237ml] of Similac brand formula daily due to concerns about insufficient milk volume. At the time of this article submission, the baby is approaching 6 months old. The patient continues to breastfeed as a supplement to formula feeding, and she continues to adhere to the medication regimen described earlier.
Reisman and Goldstein said they're "uncertain" if domperidone was necessary to induce lactation, or if the patient's hormone levels were optimised to achieve an adequate volume of breast milk. It's possible that the breast pump, which was used six times a day during the treatment phase, increased the patient's prolactin levels independently of the domperidone, report the researchers.
Looking ahead, Reisman and Goldstein would like to get a better handle on the dosing requirements, and the optimal frequency and duration of breast pump use. Also, the study didn't look into the nutritional quality of the breastmilk produced, which would be good to know. That said, Joshua Safer of Boston Medical Center told New Scientist that there's "no reason why the cells in these breasts wouldn't make milk the same way that those of non-transgender women do."
It's still early days for this treatment and there's clearly lots to learn and refine - but it's an encouraging development nonetheless.