Notes:
The primary purpose of the female human breast is to provide sustenance and nourishment to a baby, with a secondary purpose of attracting a high-quality mate to father the child. While almost all transsexual women focus on the later and proudly regard their breasts as an important sign of their femininity and womanhood, few really consider their primary biological purpose. No authoritative medical studies seem to have been conducted on the maternal desires and instincts of transwomen. However, it seems safe to claim that a substantial proportion of transwomen would like to be a mother and nurture a baby, particularly if they are also it's genetic father. In recent years an increasing number of transwomen have realised from articles (including this website!) that is possible for them to breastfeed. Statements by anti-transwomen campaigners such as Milli Hill's "Male people, however they identify or describe themselves, cannot breastfeed” are factually incorrect. In 2005 an English newspaper published a story about a young woman breastfeeding her baby in a restaurant, she was asked to leave and wasn't at all happy about that. Not really headline material, but readers then discovered that the woman in question was a male-to-female transsexual. As a 'husband', she had begun female hormone treatment at about the same time as his/her wife had become pregnant. After the baby's birth, the transwoman had acupuncture to help kick-in her own milk production and was sharing nursing duties with her former wife.
In September 2022 the online magazine INSIDER published a contraversal article desribing how Some Parents Are Breastfeeding Without Pregnancy or Giving Birth. Another example is Mika Minio-Paluello, who identifies as a transgender woman and a lesbian, although still pre-GCS. In 2023 she published on Twitter a photo of her breastfeeding a baby born by her partner, hinting that IVF had been used. She had taken hormones and drugs to enable lacation and helped breastfeed the baby for a few weeks before sadly getting a cancer diagnosis that stopped this. The story was picked up by a UK television channel and she featured in a news item, causing considerable controversy about the ethics of a "man" breastfeeding. She was even reported to the National Society for the Prevention of Cruelty to Children (NSPCC), who quickly concluded that there was no risk to the child. Physical
Requirements
Motivation Inducing lactation is not easy; it will often take a lot of time and a lot of effort over a long period. The necessary motivation is essential, or failure is almost inevitable.
Whilst quite such a high success rate cannot be achieved with male-to-female transsexual women, there's no doubt that given a high degree of motivation combined with medication, support, and encouragement; lactation induction can often be successful in transsexual women. Breast Augmentation A majority of transsexual women have had breast augmentation (implants), but the chances are good that the implants in themselves will not prevent lactation. Studies show that only about 10% of genetic XX woman with implants are unable to breast feed due to damage to their breasts caused by the implants. However, unfortunately many TS women have small and underdeveloped (hypoplastic) breasts prior to breast augmentation surgery. Although breast augmentation will greatly improve the external appearance of such breasts, even giving the impression of fully developed breasts, it does not solve the underlying milk supply problem due to insufficient internal development, and it will thus still be difficult for the woman to produce milk and nurse.
With a breast that has been surgically enlarged with implants, the nipple may be more or less sensitive than normal. If the nerves around the areola were not cut or damaged during the surgery then it should still be possible to nurse fully or partially. Nerves are vital to breastfeeding since they trigger the brain to release prolactin and oxytocin, two hormones that affect milk production. The chances of breastfeeding also improve if the milk duct system is intact. It's impossible to know the full extent of damage — if any — until a woman tries to make and express milk. Once lactation starts, implants may also cause exaggerated breast engorgement with more intense than normal pain, fever, and chills. The likelihood that implants cause serious lactation and milk production problems depends directly upon the kind of surgery had. Incisions that were made under the fold of the breast (inframammary) or through the armpit (transaxillary) shouldn't cause any trouble. However, the popular periareolar method involving an incision around the areola has greater risk of problems. After millions of breast augmentation procedures using silicone implants, there is no evidence that silicone leaks into breast milk, and even if it did there is no evidence that it would then harm the baby. For example, a silicone-based medication, Simethicone, is used to treat a baby's stomach gas. Breast DevelopmentIn order to be able to produce milk internally the breast must have certain structures in place, but fortunately these are present at birth in every human, whether genetically male or female. It's also worth noting that highly visible factors such as breast size and areola diameter that are often of great importance to transsexual women in fact have relatively little effect on the breasts potential ability to lactate and the quantity and quality of the milk that will be produced. Whatever the size of her breasts, a M2F transsexual woman can still potentially breastfeed if the internal structures are in place and undamaged.
At birth the rudiments of the functional mammary gland are in place: the nipple and areola are formed along with a rudimentary system of mammary ducts extending into a small fat pad on the chest wall. The mammary gland remains a rudimentary system of small ducts until puberty when the advent of oestrogen secretion by the ovaries brings about the first stage of the four stages of mammary development: mammogenesis, lactogenesis, lactation and involution. Mammogenesis commences at puberty with the onset of oestrogen secretion by the ovaries, usually between the ages of 10 and 12 in the girl. Oestrogen causes enlargement of the mammary fat pad, one of the most oestrogen-sensitive tissues in the human body, as well as lengthening and branching of the mammary ducts. About 40% of male children also initiate mammary development during puberty due to the tendency of the testis to secrete significant quantities of oestrogens in early phases of its development. As testosterone secretion increases this function is lost. Oestrogen stimulates breast growth by acting on the mammary tissue. With the onset of the menstrual cycle the presence of progesterone stimulates the partial development of mammary alveoli, so that by the age of 20 the mammary gland in the woman who has not been pregnant consists of a fat pad through which course 10 to 15 long branching ducts, terminating in grape-like bunches of mammary alveoli. In the absence of pregnancy the gland maintains this structure until menopause. Mammogenesis is completed during pregnancy, with the gland becoming able to secrete milk sometime after mid-pregnancy. Lactogenesis (referred to as the time when the milk "comes in") starts about 40 hours after birth of the infant and is largely complete within five days. When nursing has ceased the gland undergoes partial involution, losing many of its milk producing cells and structures, a process which is only completed after menopause.
Breast
Development in the Transsexual Woman The amount of hormone induced breast development achieved in the genetically XY male transsexual woman is very age dependent. Young boy-to-girls who start female treatment during their normal puberty years (i.e. about age 12-16) are likely to reach near normal breast development. But unfortunately the amount of development that can be expected rapidly tails off as the age of the commencement of hormone increases, and older transsexual women will commonly suffer from underdeveloped (hypoplastic) breasts. Breast development
is categorised by the "Tanner Stages" scale which goes from I to V.
It can again be emphasized that there is really NO minimum degree of
breast development in order to be able to lactate; there are well
documented instances of even men with minimal Tanner I breasts producing
some milk and breastfeeding without using hormones.
Breast Development During Pregnancy It is necessary to understand how the human breast develops and prepares for milk production during a woman's pregnancy. Mammogenesis is completed during pregnancy - indeed pregnancy is the period of greatest mammary growth. Extensive lobular and alveolar development occurs only during pregnancy, also milk secretory cells only develop during pregnancy, therefore this period is extremely important in determining the number of secretory cells in the lactating gland and the subsequent production of milk. Mammary growth (of the mother) accelerates throughout pregnancy and is fastest during the later stages of pregnancy, which coincides with the most rapid period of foetal growth.
Breast
Structure of a Pregnant Woman
But perhaps even more remarkable than this visible transformation are the extensive changes taking place inside her breasts, primarily under the stimulation of high levels of oestrogen and progesterone, combined with the rising levels of prolactin from the pituitary and human placental lactogen (HPL) from the placenta.
Nestled amid the breasts fat cells and glandular tissue is an intricate network of channels or canals called milk ducts. The additional hormones released during pregnancy cause the cells of the mammary fat pad to diminish in size and their place is taken by the developing ducts and alveoli.  During
the first three months of pregnancy the milk ducts increase in number and
size; the ducts starting to branch off into smaller canals near the chest
wall called ductules. During the mid-three months a cluster of small,
grapelike, sacs called alveoli appear at the end of each ductule. A
cluster of alveoli is called a lobule; a cluster of lobules is called a
lobe. Each breast contains between 15 and 20 lobes, with one milk duct
for every lobe. During the last three months of pregnancy the alveoli
grow and mature.Milk is produced inside the alveoli, which are surrounded by tiny muscles that squeeze the glands and push milk out into the ductules. Those ductules lead to a bigger duct that widens into a milk pool or milk sinus directly beneath the areola. Milk pools (also known as sinus) act as reservoirs that hold milk until a baby suckles it through tiny openings in the nipple. Essentially the 15 or 20 milk ducts act as individual straws that all end at the tip of the nipple and deliver milk into a baby's mouth. The mammary gland becomes able to secrete milk sometime after mid-pregnancy, and begins to produce small amounts of a protein- and fat-rich secretion sometimes referred to as precolostrum. It seems likely that mammary development continues through the duration of pregnancy since milk secretion by mothers of premature infants often appears to be diminished. The onset of copious milk secretion (or lactogenesis) is held in check by the high levels of circulating progesterone until after childbirth.
Differentiation of the breast to its mature status occurs by the third month of pregnancy, although it will take about 6 months for the breast system to fully develop and become functional for lactation. Indeed, mammary growth will continue right up to birth, and even after if nursing. In a pregnant woman, by time the baby is born, glandular tissue has replaced most of the fat cells and accounts for the much-enlarged breast. The increase in size varies greatly with the individual, ranging from zero to 800 cc of volume (and 1½ lb of weight!) per breast; the average being about 400 cc. It is normal for women to increase by one or two cup sizes during pregnancy, although this will decline (sometimes dramatically) after the cessation of lactation. Oestrogen and Progesterone Optimal mammary growth requires both oestrogen and progesterone hormones.
Together, these result in growth of the lobular and alveolar system.
Both hormones are elevated during pregnancy, which is why there is no
such "lobuloalveolar" growth during a woman's oestrus (fertility) cycle,
when only one of these hormones is elevated at a time.
Progesterone is elevated throughout gestation (required for maintenance
of pregnancy), while oestrogen is particularly elevated during the
second half of gestation. Consequently, most of the mammary growth
during the first half of gestation is mainly ductal growth and lobular
formation. In the second half of gestation, ductal growth
continues, but most growth is lobuloalveolar.
During pregnancy, the mammary tissue has oestrogen receptors and progesterone receptors. During lactation the mammary gland has oestrogen receptors, but not progesterone receptors. Other hormones As well as the oestrogen and progesterone hormones well known to transsexual women, there are several other hormones important to breast development and milk production. Indeed, mammary development in the pregnant woman takes place under the influence of an extraordinarily complex mix of hormones, including:- prolactin, human placental lactogen, estradiol (a type of oestrogen), progesterone, insulin, cortisol, growth hormone, thyroid hormones ... Prolactin is a protein hormone secreted from the anterior pituitary gland, as well as assisting in breast development; it stimulates and controls the actual production of milk. In a pregnant woman, the placenta produces an important hormone called Human Placental Lactogen (HPL) which adjusts the maternal metabolism. One of its functions is similar to prolactin, i.e. stimulation of milk production by the mammary glands. HPL seems to work with oestrogen and progesterone to increase the number of alveoli in mammary glands and also plays a role in making the alveoli functional (capable of producing milk). It's thought that the level of HPL hormone activity in the maternal blood regulates the extent of mammary development during late pregnancy. HPL also causes the secretion of a form of milk called colostrum from about the fifth month of pregnancy. Yet another, and apparently unimportant, hormone is secreted by the pituitary gland of a pregnant woman, Melanocyte Stimulating Hormone (MSH). Its only known effect is to stimulate the skin to produce pigmentation, causing the aeroli to enlarge and darken.
Lactogenesis Lactogenesis is associated with an abrupt increase in milk volume secretion, which goes from a mean of about 50 ml per day on day 2 of lactation to about 500 ml per day on day 4. After this time there is a gradual volume increase to about 850 ml/day by three months postpartum. There are also profound changes in milk composition during the early post childbirth period as the production of milk products comes into high gear. By 10 days after childbirth the milk has assumed the composition characteristic of mature milk. There are minor composition changes that continue throughout lactation. Full lactation, or the secretion of mature milk, continues as long as the demand is there, up to three to four years for infants in some cultures. Three factors are necessary for successful lactogenesis: a developed mammary gland, continued high plasma prolactin levels, and a fall in progesterone and oestrogen levels that otherwise inhibit lactation - it can therefore be partially inhibited by high doses of oestrogen. It is important to note that the milk "comes in" at the same rate whether the infant suckles during the first 48 hours or not. Thus the onset of milk secretion depends, not on milk removal from the breast, but on the changes in hormonal status associated with child birth. However, continued milk secretion depends on milk removal from the breast, the involutional process sets in after only 3 to 4 days if breast-feeding is not initiated.
Breast Stimulation in the Transsexual Woman
Hormonal
Stimulation
If only a minimal degree of lactation is being attempted then the high oestrogen regimen may be as short as two weeks. But if full lactation is desired, then the transsexual woman must try to induce all the necessary developmental changes in her breasts by simulating a full period pregnancy by taking high doses of oestrogen and progesterone hormones for a period of at least six months (probably not coincidently, a premature baby born after the 28th week or sixth month of pregnancy is "viable" and will often survive, and will thus require feeding). This sustained hormone treatment may stimulate her breast in to developing and preparing for lactation, but unfortunately transsexual women with underdeveloped hypoplastic breasts are unlikely to succeed in this endeavour as their breasts will fail to respond to the additional hormones.
Assuming that the hormones have an effect, the period of the most visible breast growth is often during the first eight weeks of treatment. This enlargement is potentially just temporary as it's primarily due to engorgement of the blood vessels, enabling increased circulation to the breasts. Thereafter, oestrogen hormones stimulate cell mitosis and growth of the ductal system, the development and differentiation of the glandular tissue (lobules and alveoli) is dependent on progesterone, whilst breast fat accretion seems to require both. Regarding other hormones found in pregnant woman:
Mechanical Stimulation Most genetic women and some men can induce lactation to some extent with only mechanical stimulation. This consists of breast massage, nipple manipulation, and sucking - the later either by a baby or by expressing using a good quality electric breast pump with a double pump kit. Realistically expression by hand, or even with a hand pump, is simply not a practical alternative to an electric double breast pump given the frequent and prolonged sucking required on each breast. A possible expressing regime: Begin by expressing each breast for about five minutes, three times a day. Increase the length of the pumping session as you become more comfortable, until you are expressing for a total of about 15 to 20 minutes on each breast every two to three hours during the day. Expressing both breasts simultaneously by double-pumping obviously saves a lot of time every day by this point! You must include nighttime pumping sessions, allowing just one long 4-5 hours period of sleep. Constant expressing will soon get to become hard work, when after a week you still haven't seen any milk at all, try not to become discouraged or concerned, unfortunately it may well take four to six weeks for the breasts to begin producing milk this way. Some dedicated women have reported only finally achieving some success after two or three months pumping!
To pump effectively and increase milk supply it is essential to relax and stimulate as much as possible the milk let-down response crucial to milk expression. Suitable mental or environmental stimuli such as baby photo's, imagining yourself breastfeeding, direct sucking stimulation of the nipples and immediately surrounding tissue, playing a tape of the cries of a hungry baby, ... etc, are essential aids to milk production. And a partner can greatly assist with sexually arousing mental stimulation and manual manipulation of the woman's body before, and even during, her expression period.
Expression Routine It is essential to establish a routine to both start and then maintain lactation. For example, begin by expressing each breast for about five minutes, three times a day. Increase the length of the pumping session as you become more comfortable, until you are expressing for a total of about 15 to 20 minutes on each breast every two to three hours during the day. Expressing both breasts simultaneously by double-pumping obviously saves a lot of time every day by this point! You must include nighttime pumping sessions, allowing just one long 4-5 hours period of sleep. Here are some tips to help both manual and mechanical expression:
Achieving Milk Production in the Transsexual Woman
Lactogenesis At this
point mechanical breast stimulation, particularly sucking (with
a breast pump or by a baby) should be started and an oxytocin
nasal spray used to stimulate milk release. If not already
begun a course of a prolactin enhancing drug
such as domperidone (brand name Motilium) is highly
recommended to help milk production. [Although the US
Federal Drug Administration
warns against using the anti-nausea drug for this purpose.]
Success is not guaranteed, but some milk production can be expected in a
majority of cases. Milk production typically begins between 1-4 weeks
after initiating stimulation using prolactin enhancing drugs, although it
can be as little as 2-3 days if hormones were taken and were effective, or
as long as 4-6 weeks if relying purely on mechanical stimulation. One
study of induced lactation using enhancing medications describes the onset
of milk production being between 5-13 days. At first, the woman may
see only drops. During the time that milk production is building,
women may notice changes in the colour of the nipples and areolar tissue.
Breasts may become tender and fuller. Some women report increased
thirst, and changes in their menstrual cycle or libido.
As the body readies itself for lactation, it pumps extra blood into the
alveoli, making the breasts firm and full. Swollen blood vessels,
combined with an abundance of milk, may make the breasts temporarily painful
and engorged, but nursing or expressing frequently in the first few days
will help relieve any discomfort.
Milk Release When oxytocin reaches the breast it causes the tiny muscles
around the milk-filled alveoli to contract and squeeze.
The milk is emptied into the ducts, which transport it to the
milk pools just below the areola. When s/he suckles, the
nursing infant presses the milk from the pools into his mouth,
both manual and mechanical expression techniques can simulate
this to a reasonable degree.
A benefit of oxytocin is that it the nursing woman may feel
calm, satisfied, and even joyful as she nurses or expresses.
Maintaining Lactation The volume of milk produced is primarily a function of
demand and is unaffected by maternal factors such as nutrition or age.
Not a lot of milk will be produced unless suckling (natural or
artificial) is frequent and consistent, the milk itself contains an
inhibitor of milk production that builds up if the milk remains in the
mammary gland for a prolonged period of time. Adequate milk
removal from the breast is absolutely necessary for continued milk
production.
Nutritional Value of Induced Milk The milk brought in by inducement skips the colostral phase, instead it more closely resembles transitional and mature breast milk. It is thus not ideal for new-born babies, but studies of non-maternal women nursing after induced lactation indicate that that their infants are well-nourished. However, it must be noted that many women felt they were only providing about 50-70% of the nutrition their babies needed with breast milk alone. If a transsexual woman is nursing it is therefore also very likely that she will be able to produce only a portion of the breast milk the baby needs, and it will be necessary to boost the baby's milk intake with formula. For this a Supplemental Nursing System (SNS) is valuable alternative to the traditional bottle. The device consists of a plastic pouch to hold breast milk or formula and attached thin, flexible tubes that run down each breast to the nipple. Since the baby takes both nipple and tube into his mouth when he suckles, he benefits from all the breast milk that is available.
The number of transwomen adopting babies or having a baby via a surrogate mother other or complex arrangement is increasingly dramatically. In some instances, the transwoman is technically the baby's father as her sperm was used to impregnate an egg. There are now numerous cases where a baby's 'mother' from its birth or early adoption is a transwoman. Many of these mothers want to breast feed their baby but can't. However, a close approximation to breastfeeding - for both the baby and the mother - can be achieved using a Supplemental Nursing System (SNS). Three examples:
Achieving lactation is a challenge for MTF transsexuals (do you early want to wake up at 3:00 am to use a breast pump?), but it is quite possible as indicated at the start of this article for a transwoman to breast feed a baby.
In 2010 the Oprah Winfrey programme featured Dr Christine McGinn - the "Mum who fathered who own children". Christine is a lesbian MTF transsexual woman, before SRS she had a sperm sample frozen and this was used for an IVF procedure which happily resulted in her female partner giving birth to twins. Christine was able to breastfeed to the babies, she says: "A lot of women who adopt go through a regimen of hormones before they have their child, and that enables them to breastfeed by the time they get their child. So I just did the same protocol. It's basically simulating pregnancy with hormones, and since I transitioned 10 years ago, I had enough breast development where it was basically the identical situation."
 In 2016 I was also contacted by a 29-year-old transwoman, newly married and with an adopted baby. She told me: "[The baby] is wonderful and I was at his birth... I am breastfeeding him through induced lactation. With what I pumped and stored in advance he had only breast milk for one month.... now he has breast milk and formula. I feel great and life is very calm and lovely these days. Things in my life are so satisfying now. Now all I have to do is learn how to enjoy it!"The same woman seems to heve featured in an article by Zil Goldstein, and Dr. Tamar Reisman of the Mount Sinai Center for Transgender Medicine and Surgery in New York, published in the January 2018 edition of Transgender Health. This describes how a 30-year old transgender woman approached Reisman and Goldstein at their clinic - "the woman was pleasant, well-nourished, and her breasts were well-developed".  They learnt that her partner was pregnant
but didn't want to breastfeed, and that she was hoping to take on the
role. The clinic then conducted probably the first professionally
supervised medical study in to induced lactation in a transgender woman.
The
unnamed patient was able to achieve sufficient breast milk volume to be
the sole source of nourishment for her child for six weeks after birth.
Her treatment essentially followed the basic framework already described
for induced lactation:
Key points of the study include:
A fairly significant news story in 2020 in South America was Columbian pre-SRS transwoman Danna Sultana having a baby boy - Ariel - born in July 2020. Ariel was actually gestated using Danna's sperm by her transmale husband Esteban Landrau, who was also pre-SRS but had subcutaneous mastectomy surgery to remove his breasts before becoming pregnant. At birth Ariel was presented to Danna rather than Esteban as his "Mama", and she was soon "feeding him", presumably via bottle and formula milk. The very confusing articles subsequently published appear to often be due to inexperienced journalists assuming that Danna's claim to be the mother equated to that of a cis-woman - rather than a deliberate attempt to mislead. In 2023, Naomi in the UK published on social media photos and commentary about breast feeding her baby - which caused some controversy. A pre-GCS transwoman, Naomi says that after disscusions with her fiancée, who also has two children from a previous marriage, they decided that she was best placed to feed the baby: "My fiancée wasn't really able to keep up a supply of milk, both due to some troubles with her body as well as working late nights at the hospital, so there was no time for her to keep an established supply. But I have a very flexible schedule with my work as a researcher, so I was able to essentially produce the milk our child was on. It ended up working out really well and had been something that I always wanted to do as a mother."
A new-born baby needs about 500ml of milk a day, increasing to 1000ml by six months. After the baby was born, Naomi found that she was able to produce around 150ml of breast milk per day over five pumping sessions, this had to be supplemented by formula milk to make up the gap. Two weeks after the birth, she also started breastfeeding once or twice a day “with good success”. Naomis says that being able to nourish her child was a life-changing and powerfully affirming experience. "It’s made me feel close to my child in such a way that’s so motherly, ... it’s natural and it feels so right to be able to provide for my child in that kind of way.”
For a person born male to breastfeed, they must develop milk-producing glands by taking estrogen and progesterone hormones. A drug is then required to lactate, such as domperidone, which is often prescribed to women struggling to breastfeed, and helps to stimulate the production of prolactin – a separate hormone that tells the body to produce milk. Prolactin and oxytocin, the hormones which govern lactation, are pituitary, not ovarian hormones (such as oestrogen). There are currently no human prolactin medications available, but in 2001 I spotted whilst doing some research that the anti-nausea drug domperidone (brandname Motilium) was described as having the side effect of increasing production of prolactin by the pituitary gland - which is found on both genetic men and women. Prolactin is the hormone which stimulates the cells in a mother's breast to produce milk, and I thus speculated that taking domperidone could help transwomen to induce lactation by effectively tricking their body and breasts into thinking that she was pregnant.
In the years since then, Domperidone has become regularly prescribed to help breastfeeding mothers, and importantly a 2015 study shows that it doesn’t “substantially alter the nutrient composition”. I was recently amused to read a 2018 medical article which described their prescription of Domperidone as a breakthrough development in promoting lactation in transgender women. Domperidone, also known by the brand name Motilum, was not intended for this, but is prescribed off-label by doctors, despite the manufacturer, Janssen, itself recommending against it because of possible side effects to a baby’s heart. The patient leaflet for Motilium says: “Small amounts have been detected in breastmilk. Motilium may cause unwanted side effects affecting the heart in a breastfed baby. [It] should be used during breastfeeding only if your physician considers this clearly necessary.” USHT believes the practice is safe, adding that hospital staff “advise any parent who is taking medication (for whatever reason) to seek advice on the possibility of that medication being transferred to the baby through breastfeeding and also the health implications for the baby”.  In many countries domperidone tablets are available without
a prescription. A typical dose is 20 milligram's (two 10 mg tablets)
four times a day, i.e. about every 6 hours. After starting domperidone, it may take three or four days before any effect is noticed,
though some women have nipples leaking milk within 24 hours. It appears to take
two to three weeks to get a maximum effect. Most women take
domperidone for 3 to 8 weeks, but women who are nursing adopted babies
usually take the drug continuously in order to maintain lactation.
Domperidone can cause stomach or digestive
upsets, but this is usually due to taking an excessive dose.Another related but older medication is metoclopramide (brand names Maxeran and Reglan), this is also known to increase milk production but it has frequent side effects which have made its use for many nursing mothers unacceptable (fatigue, irritability, depression). But in general domperidone is much preferable; it has fewer side effects because it does not enter the brain tissue in significant amounts. Genetic women trying to start lactation are advised that prolactin enhancing drugs need only be started only after the ending of any oestrogen treatment as oestrogen, particularly those types found in contraceptive pills, retard the start of lactation. However, many transsexual women seem to gain considerable benefits from the breast developing effects of prolactin even if it's not initiating lactation because of their high oestrogen intake, and thus should not be deterred from early use. Some women find that herbal seed capsules such Blessed Thistle and Fenugreek help increase their lactation, and these are very commonly taken.
Hormone Regimen I have been repeatedly asked for typical regimen for hormonal stimulation of the breast for lactation. I am not a medical practitioner, and there are many factors that must be taken into account when determining the best regime and these must all be discussed with your doctor. As an example only, and derived from just limited evidence, the following daily regimen may be appropriate for a post-SRS woman under 40 years: 1 x Premarin tablet from Wyeth-Ayerst, containing 1.25mg Conjugated Estrogens, twice daily
Many years after arriving at the above regimen, I found on social media a transwoman who claimed to be successfully breastfeeding her partners baby after using the following regimen in the final few months before birth: 1. Continued taking estrogen (estrodiol) as usual but added 200mg Progesterone daily. Maintained for 8 weeks. 2. Began breast pumping at least 8 times a day, including once around 3 am. Added 10mg Domperidone every 8 hours for a week 3. Increased Domperidone to 20 mg 4. Six weeks before due date, stopped taking estradiol 5. Four weeks before due date, began taking Fenugreek (6120mg) and Blessed Thistle (390mg) three times a day 6. When baby arrived, ceased pumping and gradually reduced Domperidone to zero. The woman admits that after a few days she restarted taking estrogen at half the previous dose as total cessation was causing her too "feel like garbage [with bad] mood swings". "Attempted lactogensis" means reverting to the prior hormonal regimen in order stimulate the start of milk production and lactation, this must involve a considerable reduction in oestrogen and progesterone hormone intake, in pre-SRS women it may require a reduction to less than their normal regimen. If a baby is to be nursed then medical advice should be sought as to what hormones can still be safely taken and in what dosage, and any anti-androgens being taken must be stopped. Prolactin-enhancing drugs should continue to be taken, e.g. 2 Motilium tablets every 6 hours, each containing 10 mg domperidone maleate. Antiandrogens may be helpful to a pre-SRS transsexual women trying to induce lactation, but they must stopped before breastfeeding. The most commonly used antiandrogens are spironolactone (brand name Aldactone), flutamide (Eulexin) and cyproterone acetate (Androcur). In the late 2010's things changed significantly when the medical profession finally decided to support the inducement of lactation in transwomen. Since then lactation regimens for transwomen that roughly mimic the hormones levels of a pregnant cis-woman have become increasingly successful and standardised, as shown in the diagram below.
Nursing  Breastfeeding
is usually strongly recommended by doctors; it is by far and away the best
and most convenient way to feed a baby. Not only will the baby be
healthier, but it also helps the new mother lose weight more easily.
Calories are burned during milk production; indeed some of the weight
gained by a woman during pregnancy is intended to be used during
lactation. Breastfeeding also releases a
hormone in the woman's body that acts as a natural tranquillizer, filling
the mother with a sense of calm and well-being while she is breastfeeding.
The female hormones taken by transsexual women induce breast development ranging from the slight to full. Typically their breasts appear unsatisfactorily small and about 50% of transsexual women have breast augmentations. However even very small breasts - particularly those of women who begin hormones before their 30's - can often function as nature intended, i.e. feed a baby. Breast augmentation, common in transsexual women, does not normally prevent breastfeeding. The main reason that breastfeeding may not be recommended or encouraged by the physician is if the drugs and other hormones being taken may make the milk unsuitable for nursing. Once the baby is born, the transsexual mother may well be able to experience the final physical act of pregnancy and birth and attempt to nurse her new baby - albeit with many assumptions such as being well enough after the delivery and her breasts are adequately developed and haven't been badly damaged by augmentation. There are already a few instances of transsexual women lactating and even breastfeeding the babies of ex-wives or female partners. Breast Pumps If you don't have a baby or young child to nurse then hiring or buying a good quality, fully automated, electric breast pump that closely imitates the natural rate and rhythm of a baby's suck pattern is essential in order to regularly artificially stimulate let-down and express milk. Some automatic pumps can "double pump" (i.e. pump both breasts at once) thereby increasing prolactin levels and milk production while at the same time decreasing the amount of time a pumping session takes by about half to about 15 minutes.
Breast Milk Quality A major objection to transwomen breastfeeding has been the claim that the quality of the milk can't possibly be equivalent to that of natal cis-woman, indeed it might even be dangerous to the baby because it was full of drugs. Despite the lack of evidence to support this argument, it has undoubtedly deterred many transwomen from attempting to lactate in order breastfeed their babies. In fact, the limited available evidence is very evenly balanced, with a strong possibility that breast milk produced by a transwomen who were assigned male at birth is as good for babies as that produced by a mother who has given birth.
But some experts have rejected the USHT's claims, pointing that there have been very few recent publications, the vast majority have not looked at what's in the milk itself, and overall lack of scientific studies on such side effects. Also, the 2022 study lasted for just five months, no long-term data was obtained and the sample size was very small (an inevitable result of very few potential candidates). Inducing and maintaining lactation requires:
Backlash The mid-2020's has seen a huge backlash against transgender women (i.e. born genetically XY male), some I fear is deserved. An unfortunate bilateral casualty has been the concept of transwomen breastfeeding a baby. Newspapers articles and Internet boards and forums have let loose at transwoman taking "dangerous cocktails of hormones and drugs" to induce lactation, and then forcing innocent babies to feed on the resulting "low quality milk substitute". A search of the internet certainly reveals somewhat weird pictures of bearded men "chestfeeding" babies. However, there are serious inaccuracies with this agenda. 1. The vast majority of the photos are of transmen (i.e. born genetically XX female) who before having any gender confirmation surgery decided to have a baby, and then breastfed 2. The drugs and hormones used to induce lactation in a transwoman are essentially identical to those produced in a woman's body during pregnancy and immediately after birth 3. Tests of the milk produced by a lactating woman and a lactating transwoman have found them comparable, the major difference tends to be quantity produced. Both are far superior to formula bottle feeding this doesn't provide the immunological advantages or the complex nutritional composition of breast milk. 4. The Newman-Goldfarb protocol has proved to be as effective for transwomen as it is for natal women, with many successes reported in medical papers. 5. The respected La Leche League states on a 2024 publication: 
Useful Links
Final Note: Feedback and additional contributions to this page are very welcome, your identity will remain strictly confidential unless you state otherwise. I'm particularly interested in hearing from trans-women who have experienced secretion or expression of colostrum or milk from their breasts.
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Last updated: 28 August, 2018
 Formerly the "Birth of Venus"
(c) 2000-2025 Annie Richards |
One
On
the other hand there is no doubt that the higher the development stage,
the easier it will usually be to start lactation and the greater the
likely quantity of milk produced. In general, well-developed
Tanner IV or V type breasts are really required for successful nursing
of a baby, perhaps a majority of the girls who start hormone treatment
by age 25 are likely to achieve this but most older woman will achieve
no more than Tanner III or even II breast development. Such
hypoplastic breasts are very small or narrow, lack normal fullness, and
may seem bulbous or swollen at the tip. They are also likely to be
widely spaced and one breast may be larger than the other.
Hypoplastic breasts don't develop and grow in response to any additional
hormones given in order to simulate pregnancy and prepare the breast for
lactation. Breasts of this kind have fewer milk glands than
normal, leading to milk-production problems. 
It
is appropriate at this point to distinguish between trying to achieve
some slight lactation, ranging from a few drops up to as much as 35%
that of a nursing mother, and trying to achieve full and copious milk
production as the primary sorice of nutrient for a baby. Both
require some degree of hormonal stimulation, but it's a case of for how
long, and also how well the breasts respond to the hormonal stimulation.
Stress, tension,
and fatigue all produce hormones that can reduce let-down. Avoid
smoking and excessive alcohol and caffeine - these are known to inhibit
a mother's milk production and let-down. 
Obviously
the best and most natural way to enhance let-down is by nursing a baby.
As a baby sucks a nipple they stimulate the nursing mother's pituitary gland
to release oxytocin (as well as prolactin) into her bloodstream. If a
baby is not handy, the let-down reflex can also be encouraged by using an
oxytocin nasal spray such as Syntocinon which can be prescribed by a
doctor. 
As
the milk flow increases, the lactating woman may feel some tingling,
stinging, burning, or prickling in her breasts. The milk may drip or
even spray during let-down.
If
nursing an infant is not immediately and regularly possible then in
order to maintain milk flow it will be necessary to artificially
stimulate let-down by expression using a breast pump. 
Two
hormones are necessary for this continued production: oxytocin
and prolactin. As mentioned above, oxytocin is necessary
for the milk ejection reflex that extrudes milk from the
alveolar lumen. Prolactin is necessary for continued milk
production by the mammary alveoli. The secretion of both
hormones is promoted by the afferent nerve impulses sent to the
hypothalamus by the process of suckling. However, whereas
the secretion of oxytocin is highly influenced by the activity
of higher brain centres, prolactin secretion appears to be
determined primarily by the strength and duration of the
suckling stimulus. Although prolactin levels fall with
prolonged lactation, at least some basal level appears to be
necessary for continued milk production. There appears to
be no direct relation between prolactin levels and milk
production and therefore it is thought that the rate of milk
production depends on control mechanisms localized within the
mammary gland. 
Maximum
milk production requires regular suckling or pumping every 2-3 hours.
Stimulation only every 5-8 hours will result in dramatically less milk
production. Stimulation less frequent than that will result in the
complete cessation of milk production some 1-3 weeks after it started.
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