Biological males can take medications that cause them to produce breastmilk, and some Canadian breastfeeding specialists support sustaining babies on this milk. But pediatrician Dr. Michelle Cretella says major questions remain as to the safety of this practice.
Very few studies on the topic exist. The scientific literature includes just four case reports, and only two of them look at the composition of the milk—but not thoroughly enough, Cretella told The Epoch Times.
The infants ingest some of the drugs taken by the biological males to make them feminine and to help them lactate. The associated risks are largely unknown, Cretella said.
“The greatest problem with so-called male chest-feeding, however, is not a scientific matter, but an ethical one,” said Cretella, who works with the American College of Pediatricians, an organization critical of gender-identity policies that may harm children’s health.
Some of the case reports cite the “gender-affirming” benefits of the practice, and the babies become a “prop” in this “gender affirmation,” Cretella said.
Some Canadian Lactation Experts Support Male Breastfeeding
An HIV-positive transgender person in Montreal, Margaret Pearson, has been posting on Reddit about trying to breastfeed with the help of lactation experts at Herzl-Goldfarb Breastfeeding Clinic at the Jewish General Hospital.“The most important aspect to me is attaining lactation for emotional connection with my baby,” Pearson said in a Feb. 15 post.
The clinic told The Epoch Times it could not comment on the matter due to patient confidentiality. Dr. Marina Klein at McGill University confirmed via email she has been working with Pearson as an HIV-positive patient. Klein is the research director for McGill’s Chronic Viral Illnesses Service.
Klein said she is aware of Pearson’s desire to breastfeed, though she is not personally involved in that aspect of the case. She said, with monitoring, the risk of transmitting HIV to a baby through breastfeeding is low. Pediatricians would usually suggest the baby take preventative medication, she said.
“Breast milk is breast milk,” pediatrician Dr. Jack Newman, chair of the Canadian Breastfeeding Foundation, told The Epoch Times via email. He said it is comparable to mothers’ milk.
“Each person, including in the usual situation produces milk which is specific to that person,” Newman said. “If a trans woman produces milk, it is breastmilk.”
When asked if he was aware of any studies done on the difference between a biological woman’s breastmilk and a transgender person’s breast milk, he said, “I doubt there are any studies.”
The Canadian Lactation Consultant Association told The Epoch Times via email that it doesn’t publish position statements, so it wouldn’t comment directly on whether biological males should breastfeed. But it cited a study showing milk produced by a transgender person was similar in macro-nutrients to regular breastmilk.
Nutrition, Drugs in Milk
That study was conducted by Dr. Amy Weimer, a pediatrician with the Gender Health Program at the University of California–Los Angeles (UCLA). It looked at the protein, fat, lactose, and calorie content of the milk.Another study, co-authored by Dr. Daniela Delgado at UCLA’s David Geffen School of Medicine, also found protein, lactose, fat, and calorie content similar to a woman’s breastmilk.
But Cretella noted the limitations acknowledged in the studies about how the milk was pooled together from separate secretions prior to study.
“The percentages of macronutrients that they obtained may be inaccurate,” Cretella said. “It is unknown whether drug-induced male mammary gland secretions provide the same immune and gut microbiome protection to infants as maternal breast milk.”
The drugs males must consume to feminize their bodies and lactate also concern Cretella. Four drugs of concern are progesterone, estrogen, spironolactone, and domperidone. The level of these drugs infants are exposed to through the milk are as yet unknown, she said.
Spironolactone is taken by transgender people to block the male hormone receptor. It is sometimes also used for treating high blood pressure, and in this case it is considered safe for a woman to take it while breastfeeding. But males using it as a hormone blocker may require two-to-four times the dose a woman takes, said Cretella, and it is unknown how that higher dosage may affect the milk and infant.
The earliest case report, published in the journal Transgender Health in 2018, notes that a metabolite of spironalactone has been known to cause tumours in rats. It said the daily dose a baby receives from traditional maternal milk is thought to be “clinically insignificant.”
But Delgado’s report said “data are scarce” on this issue. It said only one case study had shown a “clinically insignificant” dose in a woman’s breastmilk.
The second case report, published in the Journal of Clinical Endocrinology and Metabolism in 2021, noted as Cretella did, that most studies looking at spironolactone and breastfeeding “looked at much lower doses.”
The risks of domperidone while breastfeeding are high enough for the U.S. Food and Drug Administration to ban its use for lactation. In Canada, women are sometimes prescribed this medication to aid with lactation if their milk production is low.
It is prescribed off-label—in other words, it is not Health Canada-approved for supporting lactation. Domperidone is approved for treating gastrointestinal disorders.
The Canadian Breastfeeding Foundation’s Newman said he is not concerned about the risks of domperidone to the baby. He said “very little gets into the milk” and he doesn’t believe there is any effect on a baby’s heart, as some have said.
Cretella argues that the drug “may cause a deadly heart rhythm and is known to be excreted in breast milk,” noting the FDA has recommended against its use since 2004.
“Since males require a dose of Domperidone three times larger than what is given to women, the potential risk to the infant cannot be ignored,” she said.
Five different brands of domperidone are approved for market in Canada to treat gastrointestinal disorder, and the monographs for all of them warn against use for breastfeeding.
“Domperidone is excreted in breast milk in very low concentrations,” reads the monograph for one of them, brand name BIO-Domperidone, produced by Biomed Pharma. “Therefore, nursing is not recommended for mothers taking BIO-Domperidone unless the expected benefits outweigh any potential risk.”
A patient information leaflet for Motilium, another brand of domperidone, says “Motilium may cause unwanted side effects affecting the heart in a breast-fed baby. Motilium should be used during breast feeding only if your physician considers this clearly necessary.”
In the case reports of biological males breastfeeding, including Weimer’s, domperidone was obtained from Canada.
The Journal of Human Lactation (JHL), which published Weimer’s report, added an editor’s note about domperidone. It says the drug is not approved for use in the United States, where the study took place, except for instances in which doctors receive special access to treat gastrointestinal issues.
“JHL does not advocate or endorse the use of the drugs contained in this article or any drug included in this publication,” the note states.
Cretella is skeptical of the total composition of milk from male mammary glands, and she cited a colleague of hers, Dr. Richard Sandler, who has the same concerns.
Sandler, a pediatric gastroenterologist at Florida’s Nemours Children’s Hospital, provided a comment on the matter via email.
“It is unlikely that the macro-component (carbohydrates, protein and fat), and micro-component (including but not limited to vitamin, mineral, enzyme, microRNAs and immune) composition of male breast secretions would be optimal for infants,” he said.
“Male and female mammary gland tissue is significantly different at the genetic level so we cannot assume their products will be equivalent,” Cretella added.
‘Gender-Affirming’ Practice
In the case reports, one of the focuses is how breastfeeding is a “gender-affirming” practice.Weimer’s study follows a transgender person who is 46 years old and has been taking feminizing hormonal treatments since the age of 27.
“Contributing to breastfeeding was a meaningful and affirming experience for this non-gestational parent, suggesting that supporting TGD [transgender and gender-diverse] parents in their goals to breast- or chest-feed their infants should be acknowledged and addressed as part of gender-affirming care,” Weimer wrote.
In most cases, the patient supplemented feeding the infant and did not provide nutrition from breastfeeding exclusively. But in the 2018 report, a 30-year-old transgender person exclusively breastfed an adopted baby for six weeks. Formula was used to supplement thereafter.
Delgado’s report said “Breastfeeding can be a gender affirming practice for transgender women” and “the experience can be rewarding for both parents.”
Cretella says potential impacts on the baby, rather than the adults, should be the primary concern at all times.
Matthew Horwood contributed to this report.
