Q: Can I make milk after top surgery?
A: Research has found that post-top surgery, transmasculine individuals have varying abilities and desires to lactate. During pregnancy, there is a decent number of transmasculine individuals that have found their chests to grow to some degree, some back to pre-surgery size (MacDonald et al. 2016). This is often a shock to many who had been told by their surgeons that their surgical reduction was permanent. While many individuals are able to regrow mammary tissue after having had top surgery, the amount of milk they are able to produce varies widely on a case by case basis. Some individuals may not produce enough milk to feed their infant on their own or may not desire to chestfeed and should consider others options to feed their infant. For resources relating to milk production, visit our Lactation Resources page. To hear the lived experiences of transmasculine parents who have had to navigate how they would feed their babies, check out our Oral Histories page.
Q: What other options are available for feeding my infant outside of chestfeeding?
A: Many individuals have cited feeling judgment and distress over their lack of ability or desire to chestfeed. However, there are multiple options available nowadays to either replace or supplement natural milk supply, and the decision to chestfeed or to not chestfeed ultimately comes down to the parent and what is right for them and their family. A combination of any of the following options below can be considered in tandem.
Formulas have come a long way nutritionally, and should be embraced as an acceptable option for those who choose to utilize it (Institute of Medicine et al. 2004). While often discouraged from health organizations such as the FDA due to the risk of the spread of infectious disease or chemical contaminants, there have been transmasculine individuals who promote milk sharing as an option for those who are set on feeding their baby human milk. Pasteurizing donor milk is a method that mitigates these risks, in addition to the practice of proper storage and cooling techniques to ensure that the milk doesn’t go bad.
For individuals who still desire the skin-to-skin contact associated with chestfeeding but may not produce enough milk to fulfill their infant’s nutritional needs, the use of an at-chest supplementer allows the baby to latch and obtain milk from a bottle while still drawing whatever amount of milk is being produced by the body.
For resources relating to milk production, visit our Lactation Resources page. To hear the lived experiences of transmasculine parents who have had to navigate how they would feed their babies, check out our Oral Histories page.
Q: Can testosterone affect milk?
A: Historically, re-initiating HRT (hormone replacement therapy) has been advised against due to concern over the effects of testosterone on milk and how an infant may be affected by it (Hoffkling et al. 2017). There has been very little research conducted on this topic, but what research does exist suggests that it may not be as harmful as it has been assumed. A study of a transgender man who had re-initiated testosterone while chestfeeding found no adverse effects observed in the infant (Oberhelman-Eaton 2021). No changes in milk supply were recorded. Testosterone levels increased in the parent and in the milk throughout the study, but remained undetectable in the infant’s blood levels. While this is not definitive proof that testosterone is harmless in milk, it does offer some insight and can help guide transmasculine parents in making decisions about whether or not to restart testosterone whilst chestfeeding. Talk to your doctor about what is right for you.
Q: Does PrEP (pre-exposure prophylaxis) or ART (antiretroviral therapy) affect milk?
A: In a review of 26 studies regarding the use of TDF/FTC (tenofovir disoproxil fumarate/emtricitabine) in pregnant and lactating people, no safety concerns were identified (Mofenson et al. 2017). A study of women without HIV who used TDF/FTC found that a vast majority of their infants had undetectable levels of tenofovir in their blood (Mugwanya et al. 2016). A study of women with HIV who received a regimen of TDF/lamivudine (3TC)/efavirenz (EFV) found that none of their infants had detectable levels of tenofovir in their blood (Waitt et al. 2018).
Regardless of whatever form of PrEP or ART you are interested in, it is important to get tested regularly and talk with your doctor about what is right for you. For more information, visit the United States Government’s website on clinical information relating to HIV.