Thanks to Dr. Tamar Reisman and nurse practitioner Zil Goldstein, a 30-year-old transgender woman was able to exclusively breastfeed her baby for six weeks. Despite not going through any gender-affirming surgeries such as breast augmentation or vaginoplasty, Reisman and Goldstein were able to help their patient achieve lactation using "off-label" drugs — those which are developed for reasons other than their use. The pair then published their findings in Transgender Health [1] and believe it to be "the first formal report in the medical literature of induced lactation in a transgender woman."
The patient first approached the duo at the Mt. Sinai Center for Transgender Medicine and Surgery while her partner was pregnant but not interested in breastfeeding their baby herself. The patient "hoped to take on the role of being the primary food source for her infant," the report reads.
Wasting no time, Reisman and Goldstein started their patient on domperidone — a drug developed to treat gastrointestinal issues but also known to be a galactagogue, promoting the flow of breast milk — which she obtained from Canada, as it's currently banned in the US [2] ("due to the FDA's concern about its association with cardiac arrhythmias, cardiac arrest, and sudden death when used intravenously"). They also put her on a hormone regimen and had her mimic nursing through the use of a breast pump for five minutes on each breast, three times per day.
By three months into the regimen, the patient was making eight ounces of breast milk every day. A few weeks later, the baby was born, and she was able to exclusively breastfeed for six weeks.
By her first follow-up a month later, she was able to "express droplets of milk," so Reisman and Goldstein increased her domperidone and hormone dosages, and they upped the breast pumping to six times daily. After another month, her hormone dosages were increased again, and by three months into the regimen, the patient was making eight ounces of breast milk every day. A few weeks later, the baby was born, and she was able to exclusively breastfeed for six weeks.
"During that time the child's pediatrician reported that the child's growth, feeding, and bowel habits were developmentally appropriate," the report reads. "At six weeks, the patient began supplementing breastfeedings with 4-8 oz 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."
Despite Reisman and Goldstein's success with this patient, it's clear that more research needs to be done to discover the "optimal treatment regimen," as their report notes that they are unsure "whether all of the aforementioned components of the patient's medication regimen were necessary to achieve lactation." Particularly, they question the need to use the banned drug domperidone and say that "although there is significant literature indicating that domperidone increases prolactin levels and milk volume . . . the patient used a breast pump, which likely increased her prolactin levels independently of domperidone."
Although more research needs to be conducted, Reisman and Goldstein's success is huge for the transgender community and those within it who want to be able to try to breastfeed their children, whether they've gone through any gender-affirming surgeries or not.