ABM Clinical Protocol #33: Lactation Care for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Plus Patients

Ferri, Rita; Rosen-Carole, Casey; Jackson, Jason R.; Carreno-Rijo, Elizabeth; Greenberg, Katherine Blumoff

doi:10.1016/b978-0-323-68013-4.00077-8

Cited by 3 publications

(9 citation statements)

References 36 publications

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“…Unfortunately, there is currently a considerable lack of research about factors influencing lactation among transgender men. The lack of evidence-based recommendations, gaps in clinician knowledge and experience, and the history of discrimination and macroaggressions against transgender patients in medicine all contribute to the ongoing medical disparities suffered by this at-risk population (Dodgson, 2019; Ferri et al, 2020; Lee, 2019; McDonald, 2019). This study is a first step in building an evidence-base about gender-affirming testosterone therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Transgender and gender diverse people experience considerable health care disparities from avoidance of medical care due to a history of mistreatment. Furthermore, health care professionals often lack clinical experience and there is a significant lack of research to guide evidence-based practices among transgender and gender diverse people (Dodgson, 2019; Ellis et al, 2015; Ferri et al, 2020; Lee, 2019). To date, our review of the literature identified only a single case report of a lactating transgender man who initiated testosterone therapy at 21 months postpartum and continued to provide human milk to his child while on testosterone therapy for an additional 15 months (McDonald et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Initiation of Gender-Affirming Testosterone Therapy in a Lactating Transgender Man

et al. 2021

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Introduction: Transgender and gender diverse individuals may choose to provide their infants with human milk. Lactating transgender men may experience gender dysphoria and desire to initiate or reinitiate gender-affirming testosterone therapy. However, there is limited safety data regarding use of testosterone during lactation. Main Issue: A 30-year-old G2P2 transgender man with gender dysphoria sought to initiate gender-affirming testosterone therapy while lactating. Management: Subcutaneous testosterone was self-administered beginning at 13 months post-partum. We prospectively collected data on circulating testosterone concentrations in parent serum, milk, and infant serum over 5 months until the infant self-weaned. The infant was monitored for growth and development at routine pediatric outpatient appointments. Parent serum testosterone concentrations rose with the initiation of testosterone therapy, reaching therapeutic concentrations by Day 14. Milk testosterone concentrations also increased with a maximum concentration of 35.9 ng/dl when the lactating parent was on a dose of 80 mg subcutaneous testosterone cypionate weekly. The calculated milk/plasma ratio remained under 1.0 and the calculated relative infant dose remained under 1%. The infant had no observable side effects, and his serum testosterone concentrations remained undetectable throughout the study period. Conclusion: This is the first study with data regarding human milk and infant serum testosterone concentrations during the initiation of gender-affirming testosterone therapy in a lactating individual. This evidence can help families and clinicians with decisions regarding lactation and testosterone use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Initiation of Gender-Affirming Testosterone Therapy in a Lactating Transgender Man

et al. 2021

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“…15 The Academy of Breastfeeding Medicine Protocol #33 outlines evidence-based ways to support the unique needs of LGBTQ+ people in achieving breastfeeding by outlining protocols on inclusive language, effects of transition-related health care on lactation, methods of induced lactation, and safe access to donor human milk. 15 Examples of actionable steps toward gender neutral/affirming language include: the use of patient's affirmed name and gender; using the phrases "chest-fed" and "chest-feeding" if preferred during lactation support; titling clinics and support services with inclusive phrases such as "prenatal," "pregnancy," "reproductive," or "lactation". 15 Perinatal caregivers should be cognizant that some transgender and gender-expansive patients may have body dysphoria, surgical scars, or experiences of trauma, abuse, and violence that requires trust and respectful care.…”

Section: Gender Diversementioning

confidence: 99%

“…15 Examples of actionable steps toward gender neutral/affirming language include: the use of patient's affirmed name and gender; using the phrases "chest-fed" and "chest-feeding" if preferred during lactation support; titling clinics and support services with inclusive phrases such as "prenatal," "pregnancy," "reproductive," or "lactation". 15 Perinatal caregivers should be cognizant that some transgender and gender-expansive patients may have body dysphoria, surgical scars, or experiences of trauma, abuse, and violence that requires trust and respectful care. 15…”

Section: Gender Diversementioning

confidence: 99%

“…LGBTQ+ communities have been historically marginalized, and experiences of stigma and discrimination, both inside and outside of health care systems, have led to inequitable health outcomes when compared with their cisgender and/or heterosexual peers 15. In particular, LGBTQ+ individuals who breastfeed or chest-feed have identified highly gendered roles in the world of childbirth, physiological effects of transition (eg, hormonal and surgical), challenges of induced lactation, colactation, and intolerant hospital policies as their primary barriers to breastfeeding 15. The Academy of Breastfeeding Medicine Protocol #33 outlines evidence-based ways to support the unique needs of LGBTQ+ people in achieving breastfeeding by outlining protocols on inclusive language, effects of transition-related health care on lactation, methods of induced lactation, and safe access to donor human milk 15.…”

Section: Special Considerationsmentioning

confidence: 99%

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Innovations in Breastfeeding Support

Mestre

Excellent

Jaynes

et al. 2022

Clinical Obstetrics &Amp; Gynecology

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Despite the numerous benefits that breastfeeding confers to those who breastfeed and their infants, the United States' exclusive breastfeeding rates and any breastfeeding rates at 12 months remain low and inequitable. This public health crisis has been prioritized in the US Healthy People 2030 goals. Current evidence-based practices to support lactation have afforded limited progress, thus, achieving national breastfeeding goals requires innovative ideas in thinking, technology, and care. This article highlights potential innovative strategies in the field of lactation to improve outcomes and work toward achieving health equity, while underscoring the critical role that perinatal caregivers play in lactation support.

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Successful Co-Lactation by a Queer Couple: A Case Study

Schnell

2022

J Hum Lact

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Introduction: With cultural and social evolution and improvements in reproductive technology, an increasing number of babies are born to lesbian, gay, bisexual, transgender, intersex, queer and/or questioning, and asexual and/or ally parents. As parental roles and gender expression become more expansive, the role of breastfeeding a baby must naturally also expand to include the option of sharing of breastfeeding among parents, called co-lactation (Bamberger & Farrow, 2021). In most cases, co-lactation involves a gestational parent and a non-gestational parent. If a non-gestational parent desires to produce milk for the purpose of breastfeeding, they do so by inducing lactation. While interest in and research about induced lactation are developing quickly, little information is currently available about co-lactation. Main Issue: A couple identifying as queer presented with concerns about inducing lactation in the non-gestational parent, as well as seeking assistance in managing a successful sharing of the breastfeeding relationship. Management: Breast massage, milk expression, acupuncture, hormone therapy, and galactagogues, including domperidone, goat’s rue, and malunggay ( moringa oleifera) were used to initiate and establish lactation by the non-gestational parent. Parents shared the breastfeeding relationship equally and carefully managed milk expression when the other parent was breastfeeding to maintain or increase lactation. Conclusion: With professional lactation support, commitment to a lactation plan, responsive parenting, and strong communication and cooperation between parents, two parents were able to successfully co-lactate for more than a year. Breastfeeding was shared equally and supplementation of breastfeeds was rarely needed.

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ABM Clinical Protocol #33: Lactation Care for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Plus Patients

Cited by 3 publications

References 36 publications

Initiation of Gender-Affirming Testosterone Therapy in a Lactating Transgender Man

Initiation of Gender-Affirming Testosterone Therapy in a Lactating Transgender Man

Innovations in Breastfeeding Support

Successful Co-Lactation by a Queer Couple: A Case Study

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