You may have heard the terms chestfeeding or bodyfeeding and wondered how they relate to breastfeeding. Both describe how transgender and nonbinary parents feed and nurture their babies after childbirth by feeding them milk from their chest. Some lactation consultants, doctors, and healthcare organizations, including the Academy of Breastfeeding Medicine and La Leche League International, advocate using the term chestfeeding to support queer, transgender, and nonbinary parents. Learning more about chestfeeding can help you be more supportive and inclusive of the 1.4 million U.S. adults (estimated at 1 out of every 1,000 people worldwide) who identify as transgender.
Transgender Parenting 101: A Vocabulary Lesson
Let’s start with some definitions before diving into the mechanics of chestfeeding. First, the American Psychiatric Association defines a transgender person (abbreviated as trans) as an individual whose gender identity does not align with the sex they were assigned at birth.
A transgender man (or trans man) is a person who was assigned female sex at birth (AFAB) but identifies as male. When people do not feel like they are born in a body that matches their gender, they can experience gender dysphoria. Symptoms of gender dysphoria include physical discomfort, emotional distress, depression, anxiety, suicidality, self-harm, eating disorders, and substance abuse.
Some trans people take steps to match their physical body, name, or legal status with their self-identified gender. Gender-affirming surgery is one such step. Studies show fewer than ten percent of trans men have had gender-affirming surgery. So, most trans men still have a uterus, ovaries, and vagina, meaning they can conceive and carry a pregnancy.
What About Testosterone Therapy?
Testosterone is a hormone trans men may take to change their physical appearance and transition their physical body to reflect their chosen gender. When a person assigned female at birth (AFAB) takes testosterone, they may stop having periods, grow facial hair, and decrease the size of their breasts.
It is possible to get pregnant while taking testosterone – up to 30 percent of all pregnancies in trans men are unplanned. Many transgender men desire children and are willing to carry a pregnancy. Assisted reproductive technology (ART), such as in vitro fertilization and ovulation induction, makes it more likely that more transgender men can conceive and fulfill their family planning wishes.
Who Can Chestfeed?
Anyone can, regardless of their gender. Chestfeeding is a gender-fluid, inclusive term. Most commonly, however, it is used to describe when a transgender man feeds their child from their chest.
Trans and non-binary parents choose chest or bodyfeeding for the same reasons that cisgender women do – for the newborn and infant health benefits, convenience, and bonding.
What About Top Surgery?
Top surgery is the general term to describe a gender-affirming surgery that changes the look of a trans person’s chest. Because breasts are associated with female bodies, transmen or people assigned to be female at birth might choose to have their breasts removed or significantly reduced in size. The operation is called mastectomy – the same procedure doctors might recommend for treating breast cancer. Top surgery makes chestfeeding more difficult but not impossible. Some transmen report that they delay top surgery so that they can chest feed.
Depending on how much breast tissue top surgery removed and if the nipple size changed, latching and milk production may be more challenging. Trans and non-binary parents considering chestfeeding should meet with an internationally board-certified lactation consultant during pregnancy to help them have a successful and rewarding chestfeeding experience. Many factors can affect breastmilk supply for all new lactating parents, not just trans parents.
Regardless of the gender assigned at birth, all humans have mammary glands and hormones to produce milk. Depending on the physical and hormonal changes during pregnancy and their transition, lactation can happen for transgender men just like it does for cisgender women, even if they have had top surgery. Transgender men and other non-binary individuals AFAB should be made aware some pregnant people may experience undesired chest growth or lactation even after chest reconstruction. They will need to be supported by a knowledgeable healthcare provider and lactation consultant if they choose to suppress lactation.
How Does Chestfeeding Work?
Small studies of transgender male pregnancies report that approximately one-half of the transmen participants choose chestfeeding. Lactation consultants can help transmen induce lactation in several ways. Sometimes lactation consultants work collaboratively with endocrinologists (doctors specializing in hormones) to use hormones to start lactation.
There are other medications that, as a side effect, increase prolactin levels, the hormone responsible for milk production. Examples include metoclopramide (Reglan) and domperidone (Motilium). Medication therapy is safe and effective, but it can take several months to induce lactation.
In most cases, medication alone is not enough to establish or increase milk supply. Frequent nursing and pumping are also necessary to stimulate the breasts and remove the milk.
Can Transmen Chestfeed and Take Testosterone?
Yes. Not all transmen stop taking testosterone while pregnant, although most do. High doses of testosterone can suppress lactation. According to the U.S. Drug and Lactation Database (LactMed), skin injections of the type of testosterone used most commonly for gender-affirming treatment (testosterone cypionate) does increase milk testosterone levels but does not appear not to increase the nursing infant’s blood testosterone levels. Nevertheless, the International Journal of Transgender Health’s 2022 version of the Standards of Health for Transgender people advises that “the impact [of testosterone in breastmilk] on the developing neonate/child is unknown, and therefore gender-affirming testosterone use is not recommended during lactation but may be resumed after discontinuation of chest/breastfeeding.”
Using a Feeding Tube for Chestfeeding
Chestfeeding can also describe using a feeding tube attached to the nipple to feed the baby if lactation isn’t possible. This tube can feed the baby formula, their partner’s human milk, or donated human milk. This is sometimes also called supplementing at the breast.
Health Benefits of Non-Nutritive Chestfeeding
Some non-lactating parents choose chestfeeding to comfort or soothe their infant without milk. Non-nutritive (meaning they aren’t getting any nutrients) chestfeeding, including sucking (like infants do with a pacifier), has several identified health benefits for newborns, such as:
- building feelings of security
- increasing warmth
- helping the baby fall asleep
- providing pain relief
- promoting the sucking reflex.
Chestfeeding helps bonding between parent and infant and can protect transgender parents against some of the loneliness, isolation, fear, or anxiety they are at greater risk of experiencing in a maternity care system that frequently misunderstands or stigmatizes them.
Why not just say breastfeeding?
Because language matters, especially for trans people. The words breastfeeding or nursing may not feel like the right fit for every person becoming a parent in today’s more gender-expansive world. Pregnancy for the trans and non-binary community is full of obstacles, and many queer parents are treated with judgment, bias, stigma, or prejudice. Research shows that trans people are more likely to experience discrimination, lack of proper healthcare, and improper treatment by healthcare providers.
Using a more gender-inclusive term conveys support for pregnant transpeople. Using trans-inclusive language like chestfeeding or bodyfeeding can help them feel more welcome and understood. With your word choices, you can offer social and emotional support, reducing their risk for postpartum depression or mental health struggles.
The goal isn’t to replace the term breastfeeding completely. Instead, it’s simply to normalize the term chestfeeding to be used alongside breastfeeding, depending on what each person feels most comfortable with. Choosing the right language is one small way to help all parents feel they can find the support and resources they need after their child is born.