For many LGBTQIA+ individuals and families, the desire to nurture and bond with their children through breastfeeding is a powerful one. Inducing lactation, the process of stimulating milk production without pregnancy, is a viable and affirming option. This guide is here to support and inform you on this journey, offering an overview of the methods, preparations, and emotional considerations involved.
Understanding Induced Lactation
Induced lactation is a method that allows individuals who have not given birth to produce breast milk. This can be an empowering choice for transgender women, nonbinary individuals, cisgender women who used a gestational carrier, and cisgender women in same-sex relationships who wish to experience the intimate connection of breastfeeding. The process requires commitment and patience, as it involves both physical and emotional preparation.
Most methods use some combination of mechanical stimulation using hospital grade, electric breast pumps, as well as medications. Medication typically means higher doses of estradiol and progesterone, along with a medication called domperidone. Domperidone is not FDA approved or available in the United States and must be obtained directly from Canadian sources.1 It is best when this process is supported and supervised by a medical professional as the medication domperidone can have side effects, and its safety in this process is not established. If you’re a science nerd and want all of the in depth details about the methods to support induced lactation, read below in the details section!
Preparing for the Journey
Inducing lactation is a marathon, not a sprint. Here are some steps to prepare:
- Consult Healthcare Providers: Work with a medical provider knowledgeable and supportive of LGBTQIA+ health needs, and who is willing to support your use of gender hormones at higher doses and domperidone, which is not available in the United State.
- Plan Ahead: Start the process 3-4 months before the anticipated time of breastfeeding. This gives your body ample time to respond to the treatments. This process will take time, privacy and commitment. Make a plan for how to make this process empowering and not stressful.
- Create a Support System: Connect with supportive partners, friends, and/or lactation support groups. Emotional support is as vital as physical preparation.
Emotional and Psychological Considerations
The journey of inducing lactation is deeply personal and can be emotionally taxing. Here are some considerations:
- Manage Expectations: Milk supply can vary greatly. Most transgender women will need to supplement their infant’s feeding with donor milk or formula. Celebrate every drop of milk as a success. And recognize the importance of establishing an infant-parent bond, regardless and how much and how you feed.
- Self-Care: Emotional resilience is crucial. Practice self-care routines that nurture your mental and physical health. You will need more rest, more nutrition and fluids, along with gentle breast care as you go through the process.
- Celebrate Milestones: Acknowledge and celebrate the milestones along the way, whether it’s the first drop of milk or the first full feeding session.
In-depth Overview of the Various Approaches to Inducing Lactation
Mechanical Stimulation
Regular mechanical stimulation using a breast pump can be a starting point in this process as it increases prolactin and oxytocin hormones involved in lactation. You can start lactation by mechanical stimulation using “hospital grade” breast pumps. It is important to plan in advance, starting to breast pump for 3-4 months prior to planning breastfeeding. Frequent pumping sessions, up to 4-8 times a day, is important and requires some planning and commitment. Some people report having tried nipple stimulation with their fingers or using a transcutaneous electrical nerve stimulation (TENS) unit, which may also stimulate the lactation.2 These methods can be started without a prescription or medical visit. They require some equipment which can be purchased online and at medical supply stores. They require time, privacy, and commitment.
Medication or Pharmaceutical Galactagogues
These methods have been mostly studied in postpartum breastfeeding cis women, but there are 5 published case studies of their successful use in trans women.3-7
Domperidone, a dopamine antagonist, is a commonly used medication, but it is not approved by the FDA in the United States for any indication. In 2004, the FDA instituted a block of any personal importation of domperidone due to cardiac safety concerns.1 Using doses of 10 mg 3-4 times daily, domperidone shows an increase in volume of milk compared to placebo and metoclopramide. Volume and production appears to increase with the number of days of treatment. Mild to moderate side effects noted are: headache, dry mouth, and abdominal cramping. There is some concern for increased risk of prolonged QT syndrome and arrhythmias, especially in cis women over 60 years with cardiovascular disease. Sudden death resulting from QTc increase with oral dosing has not been reported.8
Metoclopramide, 10 mg 3 times daily, another dopamine antagonist, is one of the only United States FDA off-label prescription medications widely accepted to impact milk supply. There is not a lot of research on metoclopramide’s effectiveness or safety. There are some known, serious side effects, including new onset depression and the movement disorder tardive dyskinesia when taken for more than 12 weeks. Metoclopramide can also induce very fast and very slow heart arrhythmias that can lead to cardiac arrest.
Herbal Supplements
Galactagogues or herbal supplements are used with mixed evidence for being clinically effective to induce milk production. Most of the studies come from cis women postpartum struggling with milk production. A 2016 medical review of lactation induction identified 8 blinded, placebo-controlled trials of herbal galactagogues: Trigonella foenumgraecum (fenugreek), Asparagus racemosus (shatavari), Silybum marianum extract (milk thistle), Allium sativum (garlic), and Moringa oleifera (malunggay).9 In these studies of cis gender postpartum women who were struggling with milk production, the herbal galactagogues were either prepared as a tea or given as a capsule.
Lactation consultants do recommend these herbs, as well as Cnicus benedictus (blessed thistle), Galega officinalis (goat's rue), and Foeniculum vulgare (fennel), but there is no real evidence regarding their dosing, effectiveness or safety.
Combination Protocols
The basic combination method for lactation induction includes: increasing estradiol and progesterone levels initially, then dropping them before breast feeding to mimic pregnancy hormone cycles; adding a galactogogue to increase prolactin; mechanical stimulation by breast pump.4
There are 5 published case reports for successful lactation induction in transgender women, all using combination methods. Reisman and Goldstein, published in 2018, was the first published case of a transgender woman successfully breastfeeding.3 Their patient underwent a 3.5 month course of high dose estradiol (increasing up to 12mg) and progesterone (increasing up to 400mg), along with domperidone 10mg, then 20mg oral tabs 3 times daily. She was instructed to pump 5 minutes per breast 3 times daily. This patient was able to produce up to 8 oz of breast milk daily. Shortly before the due date, her estradiol and progesterone doses were decreased while she continued domperidone.
Wamboldt et al published the second known case report in 2021.4 This patient had been breast pumping at home. She was encouraged to continue pumping every 3 hours, and at least 4 times daily for 5 minutes on each breast. Her progesterone was increased to 200 mg daily along with starting domperidone 10 mg then up to 30 mg 3 times daily.
Weimer published the 3rd case study in 2023 that included nutritional analysis of the milk.5 Delgado published an analysis of the milk produced and suggested a protocol. In their protocol they increased the estradiol to 8 mg and progesterone to 200 mg daily, and domperidone from 10 to 20 mg 4 times daily.6 Their report showed that induced breast milk had comparable macronutrients with full term human milk of a gestational parent.
A 2024 case report underlined that lactation induction protocols commonly used for cisgender women are also effective in transgender women.7 This case report used transdermal estradiol, progesterone 200 mg daily and domperidone up to 20 mg 4 times daily. As with the other studies, while the nutritional content appears to be similar to gestational breast milk, the amount is usually insufficient for exclusive breastfeeding. This, of course, however, does not diminish the impact and importance of the breast contact for infant-parent bonding.
The Newman-Goldfarb Protocol for non-gestational cis women was published by the Canadian Breastfeeding Foundation. It includes a preparation phase with birth control pills and domperidone, followed by a pumping phase. They also recommend: eating oatmeal; herbal galactagogues such as Blessed Thistle herb (390 mg per capsule) and Fenugreek seed (610 mg per capsule); taking domperidone 30 minutes before meals for best absorption; and increasing their intake of non caffeinated fluids.
How FOLX Can Help
At FOLX Health, we are dedicated to providing comprehensive and compassionate care tailored to the unique needs of the LGBTQIA+ community. Our network of experts is here to support you through every step of your lactation journey. From virtual consultations to hormone therapy and mental health support, we offer a holistic approach that empowers you to make the best choices for your wellbeing and your family. We are not able to prescribe domperidone for lactation induction, but our FOLX clinicians can still provide other clinical support and guidance.
Resources and Community Support
Lactation Consultants: Find a consultant who has experience with induced lactation and is supportive of LGBTQIA+ families.
International Lactation Consultant Association
Support Groups: Online and local support groups can provide invaluable advice and encouragement from those who have walked the same path.
https://www.facebook.com/groups/TransReproductiveSupport
https://www.facebook.com/groups/lllinducinglactation/
Educational Materials: Books, articles, and online resources can offer detailed guidance and answer many of your questions.
La Leche League articles:
Breastfeeding info for transgender and non-binary parents
Breastfeeding without giving birth
Other articles:
Pink News- Trans women and breastfeeding
The Lactation Network- Breastfeeding FAQ for trans and non-binary Parents
Books:
Breastfeeding Without Birthing
Inducing lactation is more than a medical process; it’s an act of love and commitment. Whether you end up feeding your child a lot or a little of your own milk, this journey can create a profound connection with your child. At FOLX Health, we honor and support your dedication to your family and are here to assist you every step of the way.
Remember, this journey is uniquely yours, and every experience is valid. With the right support and resources, you can achieve your lactation goals and cherish the special bond that breastfeeding offers.
Medical Citations and References
1. US Food and Drug Administration. FDA Talk Paper: FDA warns against women using unapproved drug, domperidone, to increase milk production . June 7, 2004. http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm173886.htm.
2. Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006–. Transcutaneous Electric Nerve Stimulation. 2024 Jun 15. PMID: 29999889.
3. Reisman T, Goldstein Z. Case report: induced lactation in a transgender woman. Transgend Health. 2018;3(1):24-26.
4. Wamboldt R, Shuster S, Sidhu BS. Lactation Induction in a Transgender Woman Wanting to Breastfeed: Case Report. J Clin Endocrinol Metab. 2021 Apr 23;106(5):e2047-e2052. doi: 10.1210/clinem/dgaa976. PMID: 33513241.
5. Weimer AK. Lactation Induction in a Transgender Woman: Macronutrient Analysis and Patient Perspectives. J Hum Lact. 2023 Aug;39(3):488-494. doi: 10.1177/08903344231170559. Epub 2023 May 3. PMID: 37138506.
6. Delgado D, Stellwagen L, McCune S, Sejane K, Bode L. Experience of Induced Lactation in a Transgender Woman: Analysis of Human Milk and a Suggested Protocol. Breastfeed Med. 2023 Nov;18(11):888-893. doi: 10.1089/bfm.2023.0197. Epub 2023 Nov 1. PMID: 37910800.
7. van Amesfoort JE, Van Mello NM, van Genugten R. Lactation induction in a transgender woman: case report and recommendations for clinical practice. Int Breastfeed J. 2024 Mar 11;19(1):18. doi: 10.1186/s13006-024-00624-1. PMID: 38462609; PMCID: PMC10926588.
8. Ahmad N, Keith-Ferris J, Gooden E, Abell T. Making a case for domperidone in the treatment of gastrointestinal motility disorders. Curr Opin Pharmacol. 2006. December; 6 6: 571- 576.
9. Bazzano AN, Hofer R, Thibeau S, Gillispie V, Jacobs M, Theall KP. A Review of Herbal and Pharmaceutical Galactagogues for Breast-Feeding. Ochsner J. 2016 Winter;16(4):511-524. PMID: 27999511; PMCID: PMC5158159.
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