Last month, the Centers for Disease Control and Prevention (CDC) issued guidelines for transgender and non-binary individuals on how to feed young children or babies in which the agency professed that “Transgender and nonbinary-gendered individuals may give birth and breastfeed or feed at the chest (chestfeed)”.
Written on the section “Health Equity Considerations” at the agency’s website, the CDC stated that transgender parents who have had breast surgery can breastfeed or chestfeed their infants. In addition to this, the agency also wrote that “the gender identity or expression of transgender individuals is different from their sex at birth,” and that it “does not fit neatly into either man or woman.”
The CDC also directed healthcare providers working with transgender parents to be “familiar with medical, emotional, and social aspects of gender transitions to provide optimal family-centered care and meet the nutritional needs of the infant”, including “maximizing milk production, supplementing with pasteurized donor human milk or formula, medication to induce lactation or avoiding medications that inhibit lactation”.
Transgender women (biologically male) can produce milk through the use of different hormonal drugs in a protocol called the Newman-Goldfarb protocol. The drugs produce dynamics that mimic the way a woman’s body undergoes during the late pregnancy stage and shortly after giving birth. However, one of these drugs, named domperidone, may cause heart problem to babies, according to Food and Drug Administration (FDA).
Domperidone is the most popular option for the Newman-Goldfarb protocol as “it has a lower rate of potentially dangerous side effects, like heart palpations, muscle contractions and depression”, compared to other alternatives. It is an anti-nausea drug. It levels up prolactin, the hormone that is responsible for milk production. In small amount, domperidone can pass into breast milk which may result to babies having an irregular heartbeat. This is the reason why the FDA recommends that breastfeeding women should “not use domperidone to increase milk production” because of the possibility of serious adverse effects.
Domperidone is being used by some women who cannot undergo natural process that produces lactation such as those who adopt a child or those who conceive a child through surrogacy. This became a perfect choice for transgender women who are wanting to lactate. Domperidone is approved in the UK for treating certain gastric disorders. In the US, however, it was not approved by the FDA and it was considered an “investigational drug” because it was linked to “cardiac arrhythmias, cardiac arrest, and sudden death when used intravenously”. According to the agency’s advisory published in 2004:
“In response to reports that women may be using an unapproved drug, domperidone, to increase milk production (lactation), the Food and Drug Administration (FDA) is warning breastfeeding women not to use this product because of safety concerns.”
The Newman-Goldfarb protocol also uses other contraceptive pill for boosting the hormone estrogen. It produces physical stimulation through a breast pump. The method also includes the use of “anti-sickness medicine metoclopramide, heart medication digitalis and anti-psychotic chlorpromazine and sedative medications”. However, experts warned the public about using the protocol to mimic lactation for a reason that there are no studies on the long-term health effect of this method both for adults and for babies. According to a retired pediatrician named Dr. Paul Thomas:
“When it comes to nutrition, breast milk is best… but if making breast milk requires pharmaceutical medications with known bad side effects, the ‘milk’ produced is not ‘safe’ breast milk. It contains a concoction of chemicals that are likely harmful.”
Aside from the possible adverse effects of these drugs, experts are also warning about the lack of scientific consensus on the nutritional benefits of the milk being produced using the Newman-Goldfarb protocol. Although a recent data from the Journal of Human Lactation show that the milk produced through this method contained similar levels of lactose, proteins and electrolytes, experts still believe that it cannot be compared to natural milk produced by biological women.
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