According to breastfeeding guidelines endorsed by the Centers for Disease Control and Prevention, one option for transgender parents who want to “breastfeed or chestfeed their infants” is to induce lactation with the use of medication, but medical experts told The Defender the guidelines ignore the risks those medications pose to infant health.
07/13/23 | By Brenda Baletti, Ph.D. | The Defender – CHD
The Centers for Disease Control and Prevention (CDC) made headlines this week after the Daily Mail reported the agency endorsed “chestfeeding” by publishing guidance for trans-identified biological males on how to induce lactation.
According to the CDC’s breastfeeding guidelines, one option for “transgender parents who have had breast surgery” and want to “breastfeed or chestfeed their infants” is to induce lactation with the use of medication.
Inducing lactation requires taking a combination of drugs, including hormonal contraceptive drugs to provide estrogen and progesterone, and an androgen blocker to reproduce the “hormonal milieu” of pregnancy.
The protocol can also include a heart medication, an antipsychotic, a sedative and the off-label use of an anti-nausea drug to stimulate lactation called domperidone, which is not approved by the U.S. Food and Drug Administration (FDA) for use in the U.S.
But experts, such as retired pediatrician Dr. Paul Thomas, told The Defender they had grave concerns about “chestfeeding” as a way for trans-identified biological males to feed babies.
Thomas said the question of what is best for the baby should be the primary, if not only, concern. “When we become parents to an infant, we set aside our own needs and focus on what is best for our baby,” Thomas said.
“When it comes to nutrition, breast milk is best,” he added, 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.”
Midwife and nurse practitioner Mary Lou Singleton told The Defender:
“The needs and best interests of the child are entirely missing from the discussion of biological males who identify as females inducing lactation. When an infant is being fed milk produced by a human other than the woman who grew and birthed her, a breach in the maternal bond has occurred.
“In cases of tragedy or maternal illness, donor milk may serve as the next best thing to being nursed by one’s mother, but this should be viewed as harm reduction rather than the ideal way to feed an infant.”
Journalist Michael Shellenberger said the CDC’s disregard for the question of infant health in its recommendations shows how the agency has been politicized.
“The CDC’s ‘chestfeeding’ advice clearly has nothing to do with the well-being of infants. Its endorsement of an off-label hormone cocktail demonstrates, once again, that the CDC is a captured institution that issues guidance based on political interests rather than scientific evidence or health,” he wrote.
Doctors critical of the CDC’s guidelines told the Daily Mail they thought the CDC has a “responsibility” to disclose the lack of research and potential risks, adding that the agency is “blurring the lines between politics and science.”
Medical establishment conducting medical experiment on infants
Globally, medical experts consistently recommend that mothers breastfeed their babies exclusively for the first six months of life, citing a range of health benefits for the infant.
“For nearly all of human history and for the entire mammalian kingdom, breastfeeding is the continuation of the mother-baby relationship that starts with pregnancy,” Singleton said.
She said the milk produced for an infant “by the body of the woman who gestated and birthed that infant (what used to unequivocally be called the infant’s mother) is the perfect food for the child.”
“Science cannot replicate the evolutionary design that enables women’s bodies to respond to minute biochemical changes in the newborn and dynamically alter the quantity and composition of breast milk in response to the infant’s ever-changing needs,” Singleton said.
There are very few studies on, or even instances of, induced lactation in transgender women.
The Daily Mail indicated trans women seeking to lactate can take a combination of medicines called the Newman-Goldfarb protocol, which was initially developed for biological women who had not given birth but wanted to breastfeed a child.
But there is little evidence related to the success or safety of the protocol, even among women.
The Academy for Breastfeeding Medicine (ABM) clinical protocol suggested by the CDC cited only one study of one biological male where lactation was induced. A second case was also reported in the Journal of Clinical Endocrinology & Metabolism in 2021.
“A biological male cannot lactate without major medical intervention,” Singleton said. Inducing lactation with medications designed to override male physiology will produce ‘milk’ containing a cocktail of endocrine-disrupting drugs.”
She said we have no idea how feeding this substance to infants may harm them, adding:
“By centering the desires of biological male adults wanting to have an exclusively female experience, the medical establishment is conducting a medical experiment on infants.
“The infants involved do not have health conditions warranting their inclusion in a medical trial.”
Thomas said that, for example, “Domperidone being suggested to stimulate milk production has known side effects that should exclude it from consideration.”
The FDA warns against the use of domperidone — an anti-nausea drug that also happens to increase prolactin, the hormone that encourages milk production. The drug is not approved anywhere for increasing milk production and it is not approved at all in the U.S. because of potential health risks.
It has been known to cause cardiac arrhythmias, cardiac arrest and sudden death in adults.
In countries where domperidone is approved for other uses, the labeling explicitly states that “the drug is excreted in breast milk that could expose a breastfeeding infant to unknown risks.”
The FDA warns that because of the possibility of serious adverse effects, it recommends against the use of domperidone to increase milk production in breastfeeding women.
Both the ABM clinical protocol suggested by the CDC and the National Library of Medicine’s discussion of domperidone indicate that very few studies have been done on the effects of domperidone in breast milk.
Thomas said the same concern about potential side effects in infants applies to all of the other drugs recommended to stimulate lactation in biological males, adding:
“This is true for most anti-nausea medications, heart medications, antipsychotics, and sedatives. Just because a medication has the side effect of increasing lactation (milk production), it is not a good idea to expose babies to those medications. They all have a huge side effect profile other than the one that increases milk production.”
For example, spironolactone, used in one protocol, is typically used to treat liver and kidney disease and high blood pressure, and has caused tumors in laboratory animals.
Pantoprazole, also included in the same protocol, is a drug for gastroesophageal reflux disease that has a wide range of side effects, with particular concerns for pregnant or lactating women.
Those drugs are recommended in addition to contraceptive hormones and hormones such as Estrace, which is typically used to treat menopause and carries a wide range of potential side effects, ranging from mood disorders to problems with reproductive organs to blood clots.
In addition to the CDC, the U.K.’s National Health Service, Healthline and other websites indicate that transgender men can induce lactation with medication, without mentioning challenges or the potential side effects for the parent or child.
Given the potential risks to the infant, Thomas recommended different alternatives for non-lactating parents:
“Parents who cannot produce enough breast milk using natural supportive means should consider the nursing supplementers or a bottle, and then get all the skin time you both need [to bond with the baby] outside of the feeding window.”
He added, “Please, always put the baby’s best interests first.”
Brenda Baletti Ph.D. is a reporter for The Defender. She wrote and taught about capitalism and politics for 10 years in the writing program at Duke University. She holds a Ph.D. in human geography from the University of North Carolina at Chapel Hill and a master’s from the University of Texas at Austin.