Trans Women Breastfeeding: Behind the Conservative Meltdown

The Newman-Goldfarb Protocols are known to help people who didn’t give birth to breastfeed. The right can’t handle the fact that it works for trans moms too.

While biology is, as we’re so often reminded, not interested in people’s feelings, the feelings from anti-trans hecklers and scallywags are big and mad and all over the place as awareness has grown on the right that a process to help adoptive moms to breastfeed their infants works equally well for trans women, too. In the UK last week a cycle of stories about trans women breastfeeding resulted in a wave of over-the-top emoting from the usual suspects, from Libs of Tik Tok to Riley Gaines. Although lactating is something any mammal can do in the right circumstances, conservatives seem dismayed to be reminded that hormones are the dominant determining factor in how a human body develops, and what that body can do.

A rash of coverage of trans women breastfeeding began in the UK. There the story started with, and has remained focused on, a trans woman who appeared in a news segment who could be seen rinsing out a breast pump in one of the shots. Mika Minio-Paluello, who works on climate policy for a trade unionist organization, spoke about water shortages in the UK for an ITV segment in late June. However, it wasn’t her trade-unionism but her role as a mother that inflamed members of a notoriously anti-trans forum in the UK known as Mumsnet, who started out theorizing that Minio-Paluello was rinsing the breast pump as a prop, Transphobes at Mumsnet and beyond were only further enraged by the news that she’d breastfed her child herself (though the pump in the shot belonged to a housemate).

Mere days after this, Fox News brought the breastfeeding controversy over to the US with a story that dug up a few sentences on the CDC’s website referencing breastfeeding in the trans community. While the CDC guidance seems primarily aimed at supporting trans men and trans mascs who give birth after top surgery, it was presented by Fox as evidence the CDC supports breastfeeding by trans women because it briefly mentions the possibility in one spot. This frame was subsequently picked up by the New York Post, the Daily Caller, and many more.

screenshot from the CDC

As with many similar controversies, a frenzy of activity among right wing writers and anti-trans activists commenced, with each trying to one–up the other’s performative disgust over trans women’s bodies, and troll accounts searching out examples of lactating trans women to direct the anger and aggression of conservatives towards (a phenomenon also known as stochastic terrorism).

None of this should take away from the science behind human lactation, which is really neat! It turns out that the process of inducing lactation in someone other than the person who gave birth is neither new nor confined to transgender moms. In parts of Africa, relactation (induced lactation for a woman who has previously breastfed) is a common cultural practice that has been leveraged to feed children of women with HIV or AIDS. Folklore, particularly in the Muslim world, contains many stories of women who breastfed children other than their own, including tales of virgins doing so without ever having given birth. There are also rare reports, bordering on folk tales, of cis men breastfeeding children under rare conditions. 

In Western medicine, hormonal conditions resulting in cis male lactation have long been documented, and the understanding of how both breast growth and lactation can be produced in cis men using hormones goes back at least as far as this study from 1954. Although the literature on this question isn’t entirely clear, at least one study has suggested that the composition of such men’s milk is within the normal range of human breast milk produced in the more typical way.

It’s clear that lactation is therefore perfectly possible in people of all sexes. However, when it comes to producing enough milk to nourish a child, the medical conversation has centered on a process called the Newman-Godfarb Protocols for Induced Lactation. This protocol starts with the use of hormonal birth control, which is known to work by mimicking the hormonal balance found in pregnancy, preventing new pregnancies from starting. After several months of that pregnancy-like hormone balance, patients abruptly stop taking the birth control, mimicking the hormonal change that comes with giving birth. Newman-Goldfarb then has patients begin taking an anti-nausea medication called domperidone which is known to increase levels of prolactin, the hormone that triggers milk production. They also have to pump for several hours every day to stimulate milk production, even being told to wake up at night to simulate the night-time feeding routine.

Domperidone is known to have lactation as one common side effect in patients, including cisgender men. It’s not the only medication which increases prolactin, but it’s considered one of the safest. While it may also be possible to induce lactation simply by stimulating the breasts without an added medication to increase prolactin, domperidone seems to increase the amount of milk produced, bringing it closer to the amount needed to nourish a child. Even so, many women who follow the protocols (both trans and cis) find they need to supplement their milk production a bit to keep their baby fed.

The use of domperidone isn’t entirely uncontroversial, especially in the US. It comes with concerns about a rare, but serious side effect, specifically an increased risk of heart failure for at least some patients. While the drug is widely used in Europe, Canada, and Australia, including being sold over the counter in many countries, the FDA in the US has not approved it due to these concerns. It is generally believed that only trace amounts of the drug would be transferred to a breastfeeding infant, but this has not been established conclusively as yet.

All of this is true without trans women being involved yet. Cisgender moms have used the Newman-Goldfarb protocols to breastfeed adopted infants and children born through surrogacy for quite a while, with several news articles covering the practice. This makes it possible to compare the tone and style of stories about women employing the techniques to breastfeed children, with the only difference being one set of women doing so are trans. 

In a dozen stories about adopted, surrogate, or same-sex moms using hormone therapy, one of which ran as early as 2011, another as recently as this past April, not a single one editorialized against the practice, and mentions of potential risks were muted with the focus being the emotional reactions of cis women who felt they benefited greatly from having the chance to nurse their kids. While most of these stories were in the mainstream press, rather than outlets serving the right, one article in the Daily Mail presented the Newman-Goldfarb Protocols in cheery, unconcerned terms.

screenshot from the Daily Mail

Compare that to how the same protocol is discussed in a Daily Mail article about trans women using it for the same ends:

screenshot from the Daily Mail

The stigmatizing language the Daily Mail uses here to describe breastfeeding trans moms is, unfortunately, the tip of the iceberg for over-the-top conservative reactions to the idea that some trans women induce lactation in the same way some adoptive mothers do. In the most overheated corners of the internet conservatives quickly moved to sexualized the issue, insisting that trans women who induce lactation aren’t doing it to bond with their babies or help their partners, but instead have more nefarious motives… because they’re trans. Several conservatives simultaneously insisted that breast milk that comes from a trans woman can’t possibly be milk. Right-wing media outlets in turn produced stories consisting of quoting an extremely transphobic person saying something terrible (a far too-common style of story on this beat). Here’s an example from the right-leaning sports site Sportskeeda, quoting the coach of a UFC fighter:

screenshot from Sportskeeda

This, like so many of the claims conservatives make about trans people, is completely baseless. As far as medical science knows, breast milk is breast milk.

Trans moms who breastfeed haven’t always been demonized in the media in this way. The first formal case study of a trans woman breastfeeding was published in 2018, and the story was covered widely in the mainstream press. The stories from 2018 represent a halfway point between the hateful anti-science frothing in the right wing press today and the gauzy, romanticized stories about breastfeeding by adoptive moms from 2011 to 2023. Stories from 2018 in both the Washington Post and the New York Times are heavy on scientific descriptions and light on emotional language, in contrast to the Post’s far warmer depiction of an adoptive mom using the Newman-Goldfarm protocols in 2016. In the Times article, unnamed critics are quoted reacting to the trans woman’s experience as “dangerous” and “disturbing.” Both the Times and the Post raise vague safety concerns about the quality of the milk and about the drugs used to induce lactation. In contrast, the Post’s coverage of cis women who induce lactation never questions whether the milk is the same as that of women who have given birth, and the only risk mentioned is to the patient taking domperidone. (To their credit, the Post makes clear that, while trans women’s protocol differs because they’re commonly also taking spironolactone to reduce testosterone, that drug is already considered safe for breastfeeding women.)

screenshot from the New York Times

To the extent that there are unanswered questions about the safety of domperidone for increasing milk production, these questions would apply equally to anyone who follows the Newman-Goldfarb protocols without having first given birth. The total numbers of people who do so seem to be quite low, with many stories about cis women mentioning that their doctors and nurses had never heard of the possibility before. Given the much smaller number of trans women than cis women it seems almost certain that more cis women are following the protocols than trans women are. While further research would be desirable it’s still a stretch to imagine that induced lactation presents any significant public health concern. This is especially true because inducing lactation is, by all accounts, quite difficult and time-consuming, requiring hours of pumping every day for weeks before the baby arrives.

It’s clear the current meltdown over trans women breastfeeding is not based on science or safety concerns, instead resting on the tendency to dehumanize and pathologize trans women, no matter what they do. This tendency was present even in early coverage of trans women breastfeeding, before the current crop of stories on the right. When mainstream media outlets cover trans people as medical curiosities rather than human beings, in ways they don’t do in similar stories concerning cis folks, it ultimately stems from the same prejudice that is now causing the far right to accuse trans women of monstrous perversion for feeding their children using a method developed for, and primarily used by, cisgender adoptive or surrogate moms.