So far, this blog has exclusively addressed issues faced by transmasculine folks. I started writing it from my personal experience, and I am transmasculine. However, I’ve received several questions from trans women who are interested in breastfeeding. After doing some Google searches, I realized that just as there is little to no information for trans men on this topic, there is not much written for trans women. In particular, I haven’t found any personal accounts or interviews. I will try to do my part to fill a little bit of this gap. This is part one of a mini-series on trans women and lactation. Enjoy!
Trans women, individuals who were assigned male at birth but identify and live as women, CAN breastfeed. It is possible, and totally awesome! Health care providers, volunteer breastfeeding counsellors, and trans women themselves need to learn this important, empowering fact.
Over the last few weeks, I spoke a couple of times with a trans woman and mother, who we’ll call Sarah, to better understand how she became a parent and successfully induced lactation. Sarah’s baby is now more than a year old and they still enjoy a wonderful breastfeeding relationship. I’ll give a bit of background here on conception and then launch into our lactation interview.
Sarah and her wife are both genetic parents to their baby. Sarah explained to me that many doctors, endocrinologists and trans women erroneously believe that after taking antiandrogens and hormone replacement therapy for a relatively short period of time (depending on who you’re talking to, they may say something between six months and two years), a trans woman will be permanently infertile, despite not having had ‘bottom surgery’. This is to say that even if she halts her hormone therapy, it is claimed that she will not be able to produce viable gametes. Sarah believes this claim is based not on science, but on a widespread lack of understanding of trans women’s bodies and many healthcare professionals’ lack of interest in helping them preserve their fertility.
Despite having taken hormone replacement therapy and antiandrogens for 5 years, Sarah was still able to produce what she calls ‘baby-making ingredients’ following a six-month cessation of her medication. Trans women hoping to help make a little munchkin should note that it takes about three months for their gametes to grow and mature. In addition, this genetic material is very sensitive to heat and needs to develop away from the body, below core body temperature. A trans woman who usually ‘tucks’ will need to change how she dresses for a while to regain her fertility.
Sarah banked her gametes, a choice she believes all trans women should be offered. Another five years later, when she and her wife decided to conceive, Sarah went off her hormones once again to obtain a fresh DNA contribution if possible. She was again successful, after a total of ten years on hormones and antiandrogens. The couple was able to conceive at home, an option that was far less expensive than using the previously banked material at a clinic.
They chose to have a homebirth because they wanted to avoid unnecessary medical interventions. As a lesbian couple, they were also worried about their relationship being questioned by hospital employees.
SARAH: We had the most incredible midwife for the birth. When we first met her, we explained our situation, and she used the term “non-gestational mom,” which I’d never heard before. I loved that when confronted with a situation that had been confusing for so many doctors and nurses, she had a perfect, descriptive word for my relationship to my baby, right on the tip of her tongue and didn’t stumble over whether to use ‘non-biological’ or ‘donor’ or something else inappropriate. I’m one of the two genetic moms of my baby, but I’m the non-gestational mom.
ME: So you didn’t have to educate your midwife at all about trans issues. That’s awesome! What steps did you take to induce lactation? Which health care providers did you approach for help?
SARAH: I didn’t know where to start. I looked through my health insurance booklet for an endocrinologist. There was a section that said “reproductive endocrinologist,” which sounded just right. I called a couple of different offices until I got someone to call me back.
I said to the nurse, “Here’s what I’m looking for. I know that this doctor doesn’t have any experience with this, because NO ONE has any experience with it. I’m not looking for her to know what’s going on, but I have an idea what I want to do, and I think I know what I need. I just want somebody to work with me.”
When I saw the doctor, she said, “I think this is very unlikely to work, but I’m happy to help you try.”
I didn’t feel like she added that much to the process, other than prescribing the hormones I needed.
ME: When did you first think that you might breastfeed?
SARAH: We definitely thought about it before we got pregnant. It had been a vague part of our plan. I was inspired by the book, Confessions of the Other Mother: Non-Biological Lesbian Moms Tell All. As an aside, I really don’t like this use of the word ‘non-biological,’ referring to both parents and trans people. Just because we transitioned, or just because someone’s not genetically linked to their child, that doesn’t mean we’re made of styrofoam. We’re flesh and blood, we have real live bodies that are ours, and that hold and love our children. There is no such thing as a non-biological person. But reading the book was really worthwhile, and one of the things that struck me was the difference in a mom’s experience when she had not had a breastfeeding relationship with her baby. I wanted our roles in caring for our baby to be defined as little as possible by who gave birth to him, and for us to be able to give the same kind of comfort to him. As we started reading more, I got pretty attached to the idea of breastfeeding and really hoped it would work out.
ME: What medications did you take to induce lactation?
SARAH: People sometimes say that birth control pills ‘simulate pregnancy.’ Another effect of this medication is to stimulate the development of breast tissue. If you haven’t been through a normal female puberty and haven’t had progestins in your system, birth control pills are necessary to help build milk ducts and glandular tissue. Estrogen increases during pregnancy, and then after birth it drops sharply.
I modified the Newman/Goldfarb protocol for induced lactation a bit, since I was already taking hormones. I started replacing my usual estrogen with birth control pills (Nortrel 1/35, each pill contains 1mg of a progestin and 0.035mg of synthetic estradiol) about six months before our baby’s birth. Closer to the due date, I added half my regular dose of estrogen, and then stopped taking it after the birth. Two weeks after the birth I started pumping and taking domperidone. [Note: Domperidone is a drug generally used to control nausea, but has the side effect of increasing lactation output, often quite dramatically. Domperidone for breastfeeding support is an off-label use of the drug. It can be difficult to obtain for that purpose in some countries such as the US. In others, it is much more commonly available.]
ME: We know that breastfeeding works via a supply and demand system. If the baby does not take enough milk from the gestational mother, her body will produce less milk as a result. If the baby nurses more and demands more milk, the gestational mom will produce more. In the early weeks, the amount that a baby nurses and draws milk helps to determine the gestational mother’s milk supply later on. Having the baby nurse from you, Sarah, would also increase your supply, since a healthy baby is more efficient than a breast pump at removing milk from the breast. What did you do after your baby was born? How did you protect your wife’s milk supply while bringing in your own?
SARAH: We wanted my wife to breastfeed him exclusively for about the first 4-6 weeks so that she could establish her supply. I pumped during that time. After about the third day of pumping, I started to produce some milk. It was weird, because I was used to pumping and pumping and not getting anything. I looked down that day and there were tiny milky droplets, and they were firm, almost like wax. I kept pumping, and I kept getting that weird consistency, and then the next day, it was softer. It got thinner until it was just milk. I didn’t expect it to come in like that – it didn’t come in all at once like my wife’s milk did after she gave birth. It came gradually and it took days before the first drop fell into the pump bottle. But it looked like milk, smelled like milk, and tasted like melted ice cream. You could put it in your coffee or whatever!
ME: How was your experience of latching your baby in the beginning?
SARAH: It probably helped that it wasn’t his first attempt. He pretty well knew what he was doing. He’d been nursing on my wife since he was five minutes old. I did find that, especially when I was very full of milk, my breasts were not really soft enough to go into his mouth. Some lactation consultants recommend making a sandwich to help smush your breast into the baby’s mouth, and I had to do that. When he was little, I don’t think he could get my breast far back enough in his mouth to trigger the sucking reflex without quite a bit of help from me. But after a few months I didn’t have to do that anymore. My wife and I both had more issues with nursing early on than we do now, because when babies are so small, you can’t really get very much [breast tissue]in and you have to hold their head at just the right angle.
ME: Yeah, it gets so much easier as they get bigger and stronger. How did you and your wife share nursing duties?
SARAH: When I started nursing, my milk came in quite slowly, so it didn’t seem to have any effect on my wife’s supply. I would pump every time he nursed on her, and at first, she would try to pump every time he nursed on me. That way we wouldn’t be hurting each other’s supply. After a couple of months, we stopped pumping. We were sharing nursing and had a freezer full of milk – we decided to just let it be. Neither of us had enough milk to keep him happy all day long, but we both stayed home from work for quite a while so it worked out well.
ME: How was the experience of co-nursing overall?
SARAH: The breastfeeding relationship with my son is so amazing, it’s more wonderful than I ever imagined. I feel so connected to him, and he is so bright and independent and I think part of that is having such secure attachments to both his moms. Plus, it’s incredibly convenient. I think all parents who can manage to do it should try. In the early months we got twice as much sleep because we were cosleeping and he just rolled back and forth between us to nurse when he needed to.[“Or half as much sleep”, Sarah’s wife joked.] Either of us could take him out for an afternoon without worrying about bottles or getting him back home in time for a feed.
Then when our baby was about six weeks old, my wife had to go to the hospital for surgery. She was there for almost a week.
ME: Wow, how lucky that you were both nursing then!
SARAH: It was really, really lucky. We didn’t get good breastfeeding support from the hospital. We had doctors insisting she not breastfeed because of medications when our midwife and lactation consultant knew it was fine. They gave us no support with pumping. I think that for a lot of moms a situation like that could have been the end of the breastfeeding relationship, and it was a huge help that we were both able to nurse him.
ME: Do you have any idea how much milk you ended up producing?
SARAH: It’s changed over time. I’m working outside the home now. I was pumping at work for the first four months, but he’s nursing less now and I’ve stopped needing to pump. Our baby is eating solid foods really well now. He still loves nursing and when he comes home he really wants a feed. Back when we were full on breastfeeding exclusively all the time… when I woke up in the morning if I hadn’t nursed a lot overnight, I could pump and get 4 ounces.
ME: That’s amazing! Lots of gestational moms have trouble pumping that much.
SARAH: Yeah, I had a lot of milk! I didn’t expect inducing lactation to work so well. When my wife was in the hospital and he was nursing on me all the time, I did have quite a bit of pain. We sorted that out with our midwife who realized I probably had low-grade thrush, which makes everything very painful. At first, I thought, “It must just hurt to breastfeed this much.” I found out that it wasn’t normal and we fixed it.
ME: Are you still taking domperidone now?
SARAH: I tried to wean off domperidone. The dose you have to take to induce lactation is quite high. I slowly reduced my dosage. I found though that if I took less than four 10 mg tablets per day, then my supply really suffered. The protocols for induced lactation say that if you take domperidone, you will probably need to take it until you wean. It’s not quite the same self-regulating supply and demand system as experienced by a gestational parent. Also, I’m taking half of my pre-breastfeeding dose of estrogen, which is not recommended while nursing because it can have a negative effect on milk supply. It is considered safe for the baby though.
As well, I’m currently taking one combination birth control pill that is mostly a progestin. A lot of literature says that progestin is not advised for trans women because there is supposedly ‘no benefit’ to it: it doesn’t increase breast size over estrogen alone. But that is not why I take it. When I was preparing to induce lactation [and taking progestins], my moods were so fantastic. I felt much more calm and loving, and I just really liked how I felt in myself. So, I decided after being just on estrogen for a while that I wanted to go back to having a progestin as well.
ME: Did you try to get help with lactation from any other care providers besides your midwife and endocrinologist?
SARAH: I wrote to La Leche League through their web site where you can send a message to a local volunteer. I asked if they knew anything about what we were trying to do. The response I got back was from somebody saying I didn’t have real breasts so I obviously couldn’t breastfeed. It was from somebody definitely not educated about trans issues. I think this is actually quite commonplace among health care providers, too. I don’t know what goes on in some people’s heads about trans women – I guess they think we all strap on rubber boobs or something? Yet some feel qualified to give medical advice in spite of their total lack of knowledge.
ME: People also focus so much on the amount of milk that is made and not on the relationship. So what if you didn’t produce a drop of milk?
SARAH: Yeah, exactly. People should be supported to breastfeed however they can do it. I think it’s a shame that so many people don’t think about trans people’s bodies being capable of breastfeeding, and that they don’t consider and value the breastfeeding relationship. They think it’s just about gestational moms and that no one else can do it. That presents two problems: how they think about breastfeeding, and how they think about trans people as well. Health care providers need to be more flexible and help trans people have more control over our own healthcare. We deserve to have the same choices that most other people have when it comes to our fertility and to caring for our children.
Big thank you to Sarah for sharing her thoughts and experiences with us! Watch for the next post in this series on trans women and lactation – I’ll be talking with lactation consultant, Mary Lynne Biener, and Dr. Jack Newman from the International Breastfeeding Centre in Toronto.
ew. just saw this on my dash.
i thought lesbian sex was women having sex with women in any way they fucking please?
transmisogyny from a lesbian porn star. (not surprising.) *sigh*
June 11, 2012
- Inclusivity and intersectionality
- Time and date of event
- Fundraising from organizations and parties
- Ideas for a conference agenda
We talked about how the label “queer” can be problematic for some trans women, particularly those who feel that’s a derogatory word. We still are keeping “queer,” but also including lesbian and bisexual to the list of orientations we want to include.
We discussed how we didn’t want to replicate other trans or LGBT conferences where white people will tell everyone how everyone should feel, frame things, etc. There is a need for diverse and intentional leadership and facilitation during the conference.
We talked about a rough sketch of the conference agenda. We want to put equal emphasis on racism and exclusion of trans female folk in lesbian, bisexual and queer spaces. We talked about the challenges of that.
We talked about holding fundraising events throughout the city – not just on the northside or northwest. We bounced around ideas of what kind of events would be empowering for trans female folk and trans women to come out to.
Mentioned the problems of “trans women” and trans feminine / trans female genderqueer people. We want a space that is inclusive of all different non-conforming identities within the coercively male-assigned at birth spectrum.
We talked about issues of intellectualism, class, and framing things. We want to talk about themes in an accessible way that is not looking down on anyone, and is also respectful.
We put making a time and space for the event as priority number one. We want to make it locationally accessible and to hopefully not pay for any reservation costs. We are looking at mid-October.
We talked about a first round of organizations to reach out to for sponsorship, solidarity, and to listen to!
We will have our next meeting in about two weeks (after Pride) and send out a Doodle to make sure the most people possible can meet in person. We hope to have a kick-off event during the first two weeks of July.
Thinking about No More Apologies Chicago
Things I want to see…
Principle subjects of the event:
1. the exclusion of lesbian, bisexual and queer trans women / transfeminine folks from LBQ cisgender spaces. the desirability of some trans folks over others. addressing misogyny and transmisogyny in our desires and community.
2. the intersection of racism and transmisogyny. the exclusion of trans women of color within white LBQ spaces. the need for social justice, allyship and solidarity.
3. developing new spaces, networks, and envisioning integrated and autonomous communities to address these and come out with something other than “oh we met and it was good but now it’s over.”
Leading up to the event:
- a wide variety of fundraising events that put trans women / transfeminine folk at the center. spoken word and art. i personally have this wonderful fantasy of a bunch of trans ladies / transfem folks doing drag king performances.
- locationally diverse - southside, pilsen, northside, logan, westside?
travel stipends / carpool within the city
a) keynote speaker
b) trans-centric sex ed
c) trans and cis women caucus separately
d) trans women of color, white trans women, cis women of color, white cis women caucus separately
d) ppl come back and address issues
…just getting my ideas out in the open. stay tuned to http://nomoreapologieschicago.wordpress.com
My access to healthcare has become somewhat of a mixed bag. I’ve been fortunate enough to receive insurance under my family for twenty-four years. Dental, check-ups, and even braces. But ever since I came out as queer and then as a trans woman, services have been hard to come by, and added to that, even more difficult now that I’m uninsured.
In the case of my local community, I am lucky. Here in Chicago we have a variety of transgender-friendly and women’s health providers: Howard Brown, Chicago Women’s Health Center (CWHC), and Northwestern come to mind as institutions that serve the LGBTQ community with respect, compassion, and care. One institution, though, the CWHC, I’ve found myself in a bit of a struggle with due to their oversight of trans women care.
The CWHC does great work for women, or at least those who were assigned female at birth. Yes, I get it—services fluctuate and non-profit health centers are constantly in need of money. It’s difficult to serve everyone with limited resources.
I mean, on a practical level it make sense, right? There’s an estimated 50.8% of the U.S. population that are cis women,¹ while only 2% (by “liberal” estimates) are transgender—and that includes trans men, of course. When comparing reproductive health between trans and cis women, it’s apples to oranges to kiwis, or something. The point is, all bodies are different, but the essential functions of cis women are the same, while, for trans women, it depends on surgery status, hormone levels, and generally how your transition has effected health risks and benefits.
However, we do not live in a practical society. And particularly feminist institutions don’t function on “provide the greatest good for the most people.” Feminists operate with a keen eye toward institutionalized oppression. That’s how feminist health centers got started in the first place, right? They saw the systemic exclusion and non-prioritization of women in a male-dominated field, medicine, and decided to change it—to make it more accessible to women, to give them agency, and to be treated (mainly) by other women.
So it may be a no-brainer that these services should be served to transgender people too. Not so much.
About a year ago, Chicago Women’s decided to provide hormone replacement therapy (HRT), testosterone, to trans men and transmasculine individuals—not to trans women and transfeminine ones. A year or longer ago than that, they began a trans gynecology program for this same gender group.
This makes sense on a couple levels. First, they provided expertise on gynecological service to cis women, so all you really need is some transgender 101 information to make sure transmasculine folks are comfortable doing this check-up. Secondly, and more interesting, is the historical tie between cisgender women, particularly queer cis women, and transgender men. There’s a whole other explanation why these communities are closer together than cisgender and transgender women.
First, there are community-based reasons. While no one knows exactly the “origins” of the queer-as-orientation-and-identity community, it mainly came from transgender folks (both trans women and men) and cis women. But mainly it grew out of and was claimed the cisgender lesbian community as more trans men / transmasculine folks came out.
Simply put, trans women have been so historically marginalized by lesbian, gay, bisexual, and transmasculine communities (albeit in different ways and capacities) that we were never included with “queer” in mind. Hell, Silvia Rivera, a radical trans woman and one of the leaders of Stonewall, was banished from the “LGBT” community because people yelled at her “we don’t need any more drag queens in our movement.”
Second, there’s a more specific gender and sexual orientation explanation. Frankly, I believe a vast majority of lesbian and “queer” cisgender women, even those who will stand in solidarity with trans women’s rights, stray away from us sexually, romantically, and physically because of phallocentrism and something called “gender essentialism.”² This is very much a hang up from 1970’s second wave feminism.
But honestly, what does this all have to do with a small feminist health non-profit in Chicago? I think the larger issues of exclusion—historically, communally, intimately, sexually—have everything to do with receiving basic, comprehensive healthcare. Until cisgender women truly welcome trans women as sisters, partners, lovers, and feminists, this issue will remain a sore spot in the historical wedge between us.
So, the bottom line is that CWHC decided to provide services for trans men, including hormones, over that of other women: transgender women. Our shared history in women’s and LGBT communities informs why many “feminist” communities still favor those with a biologically-assigned vulvas over women who don’t. Hence how “women’s health” still does not mean all women. Women’s reproductive health means cisgender women’s health.
I don’t expect this to change overnight. I don’t expect everyone to think of trans women when they hear “women’s health.” I don’t expect CWHC to change overnight either.
But change does not happen by itself. I’ve organized a petition to push for comprehensive trans women’s health. “Equal access and equal care” must be the slogan. That is, if trans men can get gynecology exams, then we should have prostate exams. If you’re opening up testosterone hormone services, make sure you include estrogen as well.
We’ve all made progress so far. I’m pleased to see CWHC give an apology and start focus groups for transfeminine folksthat are finally happening. I encourage anyone who is transfeminine or trans female to give input on what your needs and our needs are.
Challenge women’s health institutions. Do it for all women, not matter what their “parts” are. Who knows, maybe in a few years we’ll have Planned Parenthood providing comprehensive care for all women everywhere.
Among the queer-identified community, many people opt in for polyamory. Yet many lesbians do not. Forget the U-haul jokes here, it’s just that it’s simply not commonplace for women to even consider it as a viable option.
I see the identification of polyamory, or non-monogamy, like I see the identities of the lesbian, gay, bisexual, and transgender communities. Honestly, I believe some people are born poly, while a number of others may “choose” this path for relationships. That’s certainly not to say LGBTQ people choose their identities, but there is a certain coming out process where folks choose to be out or not in particular capacities with themselves and with others.
Poly folks are widely misunderstood, even among the LGBTQ population. In the era of where fighting for marriage equality is a cornerstone issue for lesbians and gays, polyamorous options usually get pushed to the wayside in favor of monogamy as a civil right. But I argue that acceptance and celebration of poly relationships fit the queer civil rights agenda.
By the time of this past Valentine’s Day, I found myself navigating several relationships and, in the process, myself. It has been an emotional and deeply fulfilling path, and it’s still no less important to my at-home partner and me.
I came out as polyamorous when I was 20 and, like virtually everyone poly or monogamous, it’s been a bumpy road finding balance and happiness. When I came out as bisexual, people told me I was just a sexual person, like that was the only reason I liked boys and gals. Well, I am not afraid to claim myself as a sexual person and a proud ethical slut. But my orientation and gender have little to do with how much intimacy and sex I desire.
My first poly relationship at 21 was sticky, especially since at the time I presented as male and wanted to be very fair, ethical, and feminist in my desires. This queer woman and I decided together to open up our once monogamous relationship, but rarely acted upon it. We kissed other people, we flirted, and we even had some joint, ahem, hook-ups, but we never crossed the threshold of either of us dating other people. And then there was the last month of our relationship.
I was really smitten with this other woman. We had hooked up before, a couple years ago. She went off to college, dropped out, hung out in California until breaking up with her boyfriend, and then there we were in the same town again.
My girlfriend didn’t want me to have sex with this other woman. We came to an impasse. I was about to move, I did not want to leave her, but it felt so important to be with this other woman at least for one night. One night together before I left.
Looking back on it, it wasn’t fair to my girlfriend at the time. We stayed together through it. We both regret how it went down. I also felt a little over my head navigating things where I really should have moved on.
And I did. I came to Chicago, left her, and have found many other relationships, big and small, with several people and have ended up living with my partner of a year and a half.
I’ve been also struggling to find how my relationships have changed since the beginning of my transition and coming out as a trans woman. I’m finding new attention on me, this new desirability from different queer people to be with me. It feels really great, validating, and humbling, but also strange. I feel like men in hetero relationships just don’t get the same flirtatious attention that women give each other. It’s special.
I still get butterflies in my stomach when I meet someone new that I really like. I feel happy that they show such tender affection toward me, and that I have a beautifully intimate support system that has webbed itself together.
I get really happy when I hear my at-home partner met someone new, got a phone number while we’re at a bar, or has a date coming up. It made me blush with happiness to see her at her birthday kiss a girl she’s been dating for a little while. I whispered to our friends, “that’s so hot!”
I’ve worked very hard to feel secure with myself, my independence, and my commitments to my partners. I love communicating. You really have to in order to be polyamorous.
Polyamory is certainly not perfect. Someone usually feels neglected at some point in time. Jealousy happens, even when you remind yourself how much that person loves you. Envy—feeling the pure frustration of someone else who seems to have people crawling all over them. And then the unfortunate reality that you have to prioritize people in your life, and it sucks feeling like number two or three. I’ve been on both sides of the equation.
But to me, monogamy seems to have the same problems twice fold. It’s the feeling of guilt of checking out others, a tired resignation of being with one person for the rest of your life, or the secrecy of emotions and desires where you can never be truly and wholly honest with your partner or spouse.
I know I do not take this for granted. I do not know of any polyamorous person who does. It is a wonderful tangle, an exchange, and something exciting.
So what did I do for Valentine’s? I sent a few messages to some partners and spent the whole day with my at-home partner and sweetie, Rosy.
Cis people, and cis women specifically, please stop making the cotton ceiling about YOU.
This ain’t about YOUR panties.
This ain’t about “shaming” you into engaging in a sex act you attent interested in. Or using the language of social justice to coerce someone into intimacy or sex with someone with whom they are uninterested in.
This ain’t about “shaming cis women into sex” this is about you shaming us OUT of it.
The culture of shame, disgust, devaluation, desexualization, mockery, misogyny, transmisogyny and transphobia leads to a an already desperately isolated and oppressed group to feel shamed, unwelcome, and unloveable in our own communities.
We deserve a chance at love, intimacy, and self-love just as much as any other queer woman, and we can’t get there until we address the larger problem of wholesale exclusion and near universal and vocal disgust towards us and or bodies.
“no more apologies” referenced this idea of being forced to be ashamed and bow to the comfort of cis women.
But here is a secret, those of you who are disgusted by trans women? We never wanted to have sexytimes with you in the first place.
When you make it about you, you ARE part of the problem.