As Certified Breastfeeding Counselors, it is important we stay up to date with current lactation topics. It is also important we have the skills and information to support all families. The NHS recently said evidence supports trans women’s milk as good as breast milk.
In a time where the boundaries of science and societal norms are continually being redrawn, this recent statement by the University Hospitals Sussex NHS Foundation Trust (USHT) has ignited debate in many circles.
For lactation professionals, the information, which was found in a leaked letter from the Medical Director of USHT, is important to be aware of for a few reasons. One, we should be aware of up-to-date lactation news. Two, we must be able to answer questions or point parents to the right resources to find answers. And finally, we should have the knowledge to support all families.
While breastfeeding, chest feeding, and general infant feeding can become hot topics in forums and among parents, it is important we be aware of the evidence regardless of our personal feelings.
It is important to note that the International Doula Institute and the International Breastfeeding Institute are inclusive training programs. We support and respect all students and their clients. As the NHS is a reputable health agency, and this hospital is under an NHS trust, we believe it is important to share this information with current and former students.
Trans Women’s Milk as Good as Breast Milk
The NHS, or National Health Service, is the comprehensive public-health service under government administration. In addition to overseeing access to healthcare, NHS creates evidenced-based policies and thus navigates research and implementing policies.
In a letter to campaigners, the University of Sussex Hospitals NHS Trust (USHT), said that the milk produced by trans women after taking a combination of drugs, is “comparable to that produced following the birth of a baby”.
Trans women, or people who were assigned male at birth, take hormones, including estrogen, which can lead to an increase in breast tissue. With additional hormones and drugs, they may be able to induce lactation.
Women who were assigned female at birth can also lactate with stimulation, and sometimes drugs, when they’ve never been pregnant. This sometimes occurs in the case of becoming a parent via surrogacy, adoption, or same sex relationships where the partner carried the baby.
With the increase in people from all demographics becoming parents, it is important to understand options for feeding babies. We know that breast milk provides unique and optimal nutrition for babies. Determining if milk from a trans woman can provide that nutrition, is important.
In 2021, the trust created what it refers to as Britain’s “first clinical and language guidelines supporting trans and non-binary birthing people.”
Within the guidelines were assertions about the ability of trans-women to produce milk for a baby. Citing different studies, the NHS trust says trans women’s milk as good as breast milk.
Can Trans Women Produce Milk?
The initial guidelines by the hospital trust, which runs Royal Sussex County Hospital, Worthing Hospital and Royal Alexandra Children’s Hospital among others, stated the importance of human milk for human infants. Hence the information about trans women’s milk being a suitable option.
However, these claims were the subject of a complaint made by Children of Transitioners, an organization founded to provide advice for children of parents who transition.
In August 2023, the hospital defended its stance citing evidence from five studies dating back as early as 1977. Stating “overwhelming evidence” that “human milk” is better for a baby than formula. They also cited a 2022 study which found “milk testosterone concentrations” were under one per cent with “no observable side effects” in the babies.
So, yes, some trans women can produce milk. The ability and quantity may depend on several variables, such as amount of breast tissue developed during transition. They will also typically need additional medications such as domperidone.
Is Trans Women’s Milk as Good as Breast Milk?
The leaked letter passionately defends induced lactation in transgender women, emphasizing that “human milk is neutral and ideal for infants.” As mentioned above, they cite the 2022 study which suggests comparable hormone levels and thus assumed safety.
Despite the evidence cited by the hospital, the practice of trans women inducing lactation is not without critics. Labour MP Rosie Duffield is very vocal about her opposition stating a perceived belief that babies are being used for experimentation.
Duffield’s apprehensions hinge on the concern over the risk of chemicals and medication in trans women’s milk. Without long-term evidence, could there be a risk to babies? Other experts have also weighed in on that concern.
Beyond health care and academia, the debate extends into many circles. In fact, the level of debate regarding ethical and health concerns, led to the removal of the guidance on trans women inducing lactation being removed from the trust’s website.
However, despite the removal, USHT maintains the practice to refer trans women for care to induce lactation is an evidenced based and safe option.
What Does This Information Mean for CBCs?
Ultimately, trans women working to induce lactation will likely need more care than a CBC can offer. They will need to work with a qualified physician for appropriate hormone monitoring and any recommended prescription drugs.
In most cases, they would be referred to an IBCLC familiar with inducing lactation. However, once a person has sorted the medical components, they could reach out to a CBC for ongoing lactation support.
As a CBC, you do not need to understand the entire induction process. However, it is helpful to be aware it is an option.
For non-birthing parents who wish to feed their baby, there are several options, including:
- Traditional bottle with expressed breast milk from the birth parent, donor milk, or formula
- The use of a supplemental nursing system with or without inducing lactation, breast milk from birthing parent, donor milk, or formula
- Inducing lactation to breast or chest feed
- Inducing lactation and sharing feeding with birthing parent
- Inducing lactation and expressing milk to be fed via bottle or other method.
As social norms and medical advancements continue to change, there will continue to be a variety of debates. Whatever your feelings are about this, know that this is a situation you refer clients back to their doctor to discuss risks, benefits, and options.