This Is How Your Relationship With Breastfeeding Changes When You’re Trans
by JR Thorpe
Drew Angerer/Getty Images News/Getty Images

Every so often in the past few years, transgender men have made headlines for getting pregnant and giving birth. Despite the current administration's hostility toward members of the transgender community, it's a testament to the progress this country has made generally that these men feel safe in sharing their stories (although in a perfect world, this everyday miracle wouldn't be newsworthy at all). These news items give voice to the fact that not only are there many ways to form a family, but also to how parenthood changes your relationship to your body — especially so if you're trans, and especially if parenthood, for you, includes breastfeeding.

Transgender men, it's important to note, aren't somehow "less" trans because they choose to carry children biologically. For some, becoming parents through natural birth is an easier option than going through the process to adopt. This was the case with Trevor MacDonald, who has given birth to two children. He and his partner, a gay man, worried that adoption processes in their home country of Canada would discriminate against them, and instead opted to have MacDonald carry the child. How transgender men feel about their gender identity when it comes to the physical act of feeding their babies through lactation, however, is a more complicated issue: It can have interesting implications for their legal rights, their support, and their own bodily image.

Nursing Can Raise Conflicts About Body Image

Feeding infants from the chest, even with a label that doesn't gender it either way, can still make transgender people experience difficult emotions. Many have experienced serious gender dysphoria — distress over the mismatch between their biological sex and their gender identity — before coming out as transgender. Studies and personal narratives have shown that for some transgender men, the act of feeding brings back those same negative feelings.

MacDonald is at the forefront when it comes to public expression of these feelings, not only with his own story, but with research he's done as part of a collection of Canadian scientists. He co-authored a study in BMC Pregnancy and Childbirth in 2016 which interviewed 22 transgender men, 16 of whom had chosen to breastfeed for some time after they gave birth.

Seven of those participants reported that the experience made them feel gender dysphoria all over again, and their methods of coping varied. Many reported that they kept the experience of feeding their children from the chest extremely private, away from public scrutiny. Two found the disconnect between their gender identities and the gendered connotations of lactation so overwhelming that they gave up breastfeeding altogether. Interestingly, in a 2013 study of transgender men's self-representations after bearing children, researchers noted that some transgender men who had breastfed dealt with their gender dysphoria by looking at breastfeeding as pragmatic and purposeful — the first time when mammary glands were an actual "wanted" part of the body.

On a personal level, MacDonald has also been open about how breastfeeding has shifted his own perspective about his chest surgery. While the surgery helped him align his body with his gender identity, it also impeded his ability to feed his kids, which left him feeling ambivalent about it.

The Terminology Is Becoming More Inclusive

The gendered connotations of breastfeeding are so all-encompassing that it can drive some transgender men to avoid the act entirely. But recently, the language around the act has shifted to become more inclusive: It's now becoming known as "chestfeeding" rather than breastfeeding. Chestfeeding is accurate, inclusive, and doesn't have gendered limitations. There are campaigns to call all nursing activity chestfeeding, in order to break down barriers between gender identities and "traditional motherhood," and to make transgender men and non-binary people feel more accepted when nursing their infants. Not all transgender men have adopted the term, but it's becoming more widely used as an inclusive substitute for breastfeeding.

Previous Medical Decisions Can Affect Chestfeeding

As MacDonald's experience shows, the steps that transgender men can take as part of their transitions can have physical effects on their ability to chestfeed. These difficulties can manifest in a range of ways. One of the non-surgical methods in which transgender men and non-binary people deal with breasts is binding, which uses bandages to push breasts flat against the chest. The La Leche League of Canada explains, though, that this choice can create difficulties for chestfeeding:

"Many years of binding may adversely affect the glandular tissue [of the breasts]. Binding during the immediate postpartum period increases the risk of blocked ducts and mastitis, and may impact the milk supply."

Transgender men may also opt for top surgery, which takes a variety of routes to remove mammary tissue and reconstruct nipples. No top surgery removes all the mammary tissue, so transgender men who have undergone top surgery still have the possibility of chestfeeding, but the surgery can have implications for milk production and the risk of blocked milk glands. Parents who have received this procedure often need to supplement their milk with formula or milk donations.

Hormones, too, affect one's ability to produce milk. Transgender men who've given birth face complicated choices about how soon they can resume hormone treatments designed to help them affirm their gender identity. Testosterone therapy is typically injected in some transgender men between one and four times a month, or produced by wearing patches, but has to be discontinued during pregnancy. Transgender men who are chestfeeding are explicitly warned against taking testosterone, because it restricts milk flow. (The hormone doesn't seem to have any negative effects on infants.) Being restricted from using it during chestfeeding raises potential issues of dysphoria, too.

Difficulty with chestfeeding of any kind is a fraught psychological issue, no matter your gender identity: women who intend to do it and can't demonstrate a higher risk of depression in their first six months postpartum. The sample size of transgender men or non-binary individuals who've given birth is much smaller, but there's definitely space for a study on how chestfeeding affects the mental health of transgender parents.

Chestfeeding Has Legal Implications

The BMC interviews with transgender men also revealed that, for the outside world, their chestfeeding practice contributed to an image of being a "good parent" — and that image could have wider implications for these parents' legal positions, particularly where custody is concerned. (For the non-birth parent, especially if they are not a biological parent, the presumption of parentage is not automatically assumed in some states, making adoption proceedings necessary.) Two of the men interviewed reported that chestfeeding was actively encouraged by midwives and lawyers to affect custody decisions and adoption proceedings. Transgender parents' ability to have legal custody of their kids, they reported, explicitly benefited from being seen chestfeeding in front of social workers, because it showed that the child was biologically bonded to the parent. In that sense, chestfeeding is part of the pressure matrix of parenting judgement that affects all parents, but the stakes, for transgender people, can be much higher.

Products Designed To Help Chestfeeding Aren't Inclusive

The nursing woman has a whole host of products available to help her, from formula to burping cloths to pumps — but these products tend to be marketed exclusively to women, and can make transgender men who nurse feel extremely isolated. "I hate, hate, hate nursing products with a burning passion," transgender father Sabastion Sparks told Romper in an interview in January. "I prefer to pump and store milk a lot because it's hard to nurse in public with a full beard. The milk storage bags all say 'mother's milk'. It bugs me to no end because I'm not mom, I'm dad."

The nursing product industry is a large one with many different options available, but the assumption that the user identifies as female can be frustrating for transgender fathers. Sparks told Romper he copes by crossing out the word "mother" and replacing it with terms like "Batman."

Relationships to nursing one's children do change significantly because of one's gender identity, from difficulties producing milk to gender dysphoria and a lack of cultural support. But the transgender parents pushing the envelope on chestfeeding are challenging boundaries in the name of one thing: love. And they deserve to be embraced and supported just as much as cisgender moms around the globe.