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The Bind

Trans parents chestfeeding and raising families are met with fear, resistance, and hostility from doctors and maternal spaces

Max Loganov grew up with the strong feeling that their breasts belonged to other people — first as objects of enjoyment for the men they dated, and later as tools to feed children. “I've always wanted my breasts gone,” they say. “Even when I was a teenager. I developed pretty early and it sucked. I hated it…I've always had this disconnection with my body that I didn't really quite put together until recently.” 

The 35-year-old Northern Californian never felt completely at home with their assigned (female) gender. This became particularly fraught when they first discussed having children with their partner six years ago. “I immediately had the fear of, like, ‘I don't want to do that.’” Loganov did want to be a parent, but understood the biological process their body would undergo to birth a child, and worried what this would trigger a painful feeling of displacement. 

That feeling — that they would later identify as gender dysphoria, the clinical term for the distress caused by a disconnect between a person’s gender identity and their assigned sex — persisted through their first pregnancy. It took COVID lockdown and the birth of their second child for Loganoff to realize they were (and are) non-binary. “Like a lot of people over the pandemic I kind of found my, my gender identity being at home,” they say. 

While Loganoff may have done this subconsciously, many trans men and non-binary people intentionally put off their medical or social transition until after they have kids. The institutions and discourse of parenting are at best inhospitable to trans parents. “I did feel like there was a script to follow, like you had to fall in line,” Loganoff says. “If you spend a lot of time on the internet, around the subject of childbirth and babies, it's extremely prescriptive and judgmental. So I think [I had] just this fixation on, ‘I got to do things right.’” And often, “doing things right” has no room for the trans experience. 

Cultural blindspots with clinical implications

More and more transmasculine (those assigned female at birth) people come out every day. The more kids they have, the more they push collectively to make maternal health care providers and support groups more inclusive. That push has been met with increasing resistance from anti-trans activists and medical professionals who believe that gender roles should correlate with a person’s assigned birth-sex. Among the sharpest and most misunderstood flashpoints in this conflict has been language around breastfeeding. Many transmasculine and non-binary people prefer to call it “chestfeeding.” This is a way to alleviate some of their gender dysphoria, but to their opponents, this is a dangerous new language regulation. 

While the cultural arguments around breastfeeding language may be new, trans people have been using their own bodies to feed their infant children for as long as trans people have existed. And still there isn’t something approaching a history of trans parenting. “There've been multiple genders for millennia and all of the ethnographic research about other genders outside the sort of Western binary was just about the psychology of those genders,” said Kristin Wilson, a professor of anthropology and women’s studies at Cabrillo College, and author of “Others’ Milk: The Potential of Exceptional Breastfeeding.” This blind spot persists even in modern transgender studies, where cisgender people, meaning those whose gender identity matches their assigned sex at birth, are much more curious about what they perceive as a mental difference in what makes some people trans, while ignoring the way trans people interact with systems and a society not set up for them.

These cultural blind spots have clinical implications. According to data from the 2015 National Transgender Survey, 26% of trans people report delaying preventative medical care due to fear of discrimination. Trans men and non-binary people said they were twice as likely as trans women to avoid or delay care for this reason. And this has huge implications for what it means to be a trans parent. 

Transitioning with children

Stone Rose, 25, from Nottingham, UK, is one of those people who put off their transitioning til after childbirth. He was pregnant with his first child when he first asked his general practitioner for a referral to the closest Gender Identity Clinic, a request which the doctor refused.

“He was, like, 'I'm going to be completely honest here. I’ve never done this before,'” Rose says. Rose explained that even though he was pregnant now, there was an 18-25 month waiting period before he’d get even his first appointment at the GIC, and it would take several appointments over the course of months or maybe even years before he’d be able to access Hormone Replacement Therapy, a common course of treatment for gender dysphoria.

Still, the doctor balked, consulting with other doctors in his local practice before rejecting Rose a second time. It wasn’t until Rose emailed the GIC directly about whether it was okay just to get an initial referral while pregnant that his GP relented. 

Rose now has two kids and has breastfed them both, though he’s quick to point out that at first he wasn’t sure about it right up until the moment his first child was born in 2016. He prepared for the possibility that he wouldn’t feel comfortable chestfeeding. 

“I’m one of these people [that] if I decide to do something, I have to do a lot of research into it and sort of make a really informed decision on things,” he said. The first step for him was harvesting colostrum, the first form of milk produced by mammals, including humans, when a baby is first born. According to La Leche League International, colostrum production begins in mid pregnancy, between 12 and 18 weeks and continues to be produced into the first few days post birth.

It’s usually a clear, white, or yellow substance that can provide the baby with a host of good health benefits beyond just feeding a newborn — from reducing the risk of jaundice, to strengthening a baby’s immune system.

Two to five days after birth, colostrum transitions into early milk, a mix of colostrum and more mature milk. “It was a case of, even if I don't breastfeed, then I really want to have some colostrum because it can obviously help my baby prevent diabetes and everything,” Stone said. “I suffer from hyperglycemia myself. That's something that runs in my family. So it was a case of  this might help her sugar levels in her blood sort of level out.”

When his first child was born, Rose’s partner was ready to step in and feed the newborn colostrum while Rose was recuperating. “I was completely undecided what I wanted to do up until the moment I held her in my arms, she started rooting and she started turning to nuzzling to me and I was just like, ‘I want to breastfeed her,’” Rose said. ”When she latched on, it was just like this isn't painful. This feels really nice. And it feels really right. And it feels really comfortable.”

Rose said they never had much of a parental instinct until his first time chestfeeding his first child. “I get to sit here now quietly with her and bond with her and I get to smell her and I get to cuddle with her,” Rose said. “And see her eyes close as she falls asleep. And I get to see her little hands pawing at me and it was just like, ‘Oh, this is adorable. Yeah we’re doing this.”

Studies have shown that breastfeeding commonly deepens the bond between parent and child. A 2017 study published in Developmental Psychology found that breastfeeding over a long period of time helped gestational parents develop “maternal sensitivity.” A 2014 study found that breastfeeding can help with the child’s behavioral development over time.

The experience of feeding his two children, the second born last April, was special for Rose, who describes himself as “very, very, very pro-breastfeeding.” Nonetheless, like Loganoff, Rose sees his breasts almost like tools. Tools that he’ll soon be able to put down.

“I do get dysphoria from my chest. I really like binding,” he said, referring to the practice of binding his breasts to produce a flat chest — a common practice for many transmasculine and non-binary people. He can’t bind at the moment because it could lead to blocked milk ducts, but he’s able to keep his dysphoria at bay for the time being.

“I can't bind at the moment, but having curves and everything on my chest doesn't give me any dysphoria,” he said. “My brain can rationalize it and override any dysphoria because it's a case of, I'm doing this for a purpose and this is for a better purpose than my own discomfort. This is a case of: this is what's best for my kids.”

Chestfeeding after top surgery

While many trans people, like Loganoff and Stone, wait to come out or transition until after finishing chestfeeding, it is possible to chestfeed after top surgery, or to continue breastfeeding even if they start or resume taking testosterone, which is typically part of HRT for transmasculine people and non-binary people who were assigned female at birth.

It’s widely speculated that Michael Dillon, a British trans man, was the first trans person to undergo Hormone Replacement Therapy with testosterone in 1939. The goal of masculinizing hormone therapy is the promotion of masculine secondary sex characteristics while suppressing feminine traits. It works in large part by redistributing the body’s fat from the breasts and hips to a person’s midsection. Over time, it will lower the patient’s voice and likely trigger the development of facial hair, and stop menses.

Dosing varies depending on how it’s administered — through injections, patches, or gel. Trans patients will sometimes choose to microdose T in order to take the edge off their dysphoria as a trial. Most doctors say that being on T for extended period of time will permanently sterilize the patient, but there have been many documented cases of transmasculine people seeing their fertility return after ceasing hormone treatment. It’s also possible to still get pregnant while on T, especially within the first few months of new treatment.

“Sometimes that question is asked before top surgery so that it can be done in a way that permits [chestfeeding],” said Wilson. People should “realize that there's such a range of experiences. That breastfeeding can be horribly dysphoric for a trans masculine person, or it can be totally, absolutely a hundred percent fine.”

Wilson stressed that a breast is a breast, and can produce breastmilk in people of any assigned sex at birth. There have been anecdotal accounts of trans women, who were assigned male at birth, breastfeeding their kids by taking the correct mixture of hormones to begin lactation going back decades. And doctors have recently begun studying how to safely implement a safe hormone regimen for breastmilk production in trans women. 

But for trans people, much is still unknown within the community about how hormones, top surgery, giving birth, and chestfeeding still interact. 

Testo Mom

When their child was born, Andrew was only out as non-binary to a handful of people. The 27 year-old from Kentucky knew they eventually wanted to transition, but also wanted children, and they found it easier to navigate the maternal health care system as a more femme-presenting person.

“There was a lot of gender repression while I was pregnant,” Andrew told Massive. They became a lactation specialist over time and have been chestfeeding their little one for the last 15 months. But Andrew also recently started testosterone for the first time.

Though there is little medical literature about testosterone’s effect on milk production in transmasculine people, any breast potentially has the ability to produce milk. There are countless historical accounts of cisgender men feeding infants in a pinch. The hormonal key for milk production is prolactin, which is present in bodies of either assigned sex at birth. Produced by the pituitary gland, the hormone is also released when a newborn latches on and suckles at their parent’s breast.

Starting or resuming T treatments after giving birth will eventually cause milk production to slow down or cease entirely, leaving trans parents dependent on a wet nurse or formula (and, in the future, synthetic breastmilk). 

A 2016 study in BMC Pregnancy and Childbirth looked into the chestfeeding experiences of 22 trans folks. Of the group, 16 chose to chestfeed their children over a period of time, four did not, and two were still pregnant at the time of the study. Of the group, nine had already had top surgery before conceiving their babies.

It’s an area that needs more study and Andrew is starting to see how T is affecting their chestfeeding. “It's like just physically it's made it a little more uncomfortable and I think there's less milk,’ they said. Eventually the testosterone will stop their milk production, but it’s more likely that Andrew’s physical appearance will start presenting issues first. “As gender changes start to happen, like as my voice gets a little deeper and things like that, there's more of a chance of passing. So then it becomes this thing, do I really want to pull this huge tit out of my shirt and do this?”

Andrew’s social anxiety is understandable in a moment and country that is seeing multiple states taking legal steps to further marginalize the trans community. Further, trans men don’t always benefit from the increased visibility of trans women, and so the idea of a trans man chestfeeding his child in public would perhaps come across as shocking to many.

That invisibility can make it difficult for trans men to access the care, and support they need to do things like chestfeeding their child. A lot of trans men just opt out of the child-rearing business altogether rather than risk dysphoria or public ridicule.

The language wars

The online discourse over trans-inclusive breastfeeding language doesn’t help. A few weeks ago, a hospital in Brighton, UK, released a guide for using gender neutral birthing language. Among them was a passage that suggested that some trans people may use the term “chestfeeding” rather than “breastfeeding.”

According to the hospital’s guidelines, the gender-neutral language is meant to be “additive,” and not a replacement for traditional terms. The guidelines stress that some people may react negatively to gender-neutral language, and so it’s important to consider broader sensitivities in language usage.

Nonetheless, The Times of London picked up on the story, implying that “chestfeeding” would be used in place of “breastfeeding” at the hospital. From there, the Washington Examiner, a conservative American publication, ran a piece claiming that the word “breastfeeding” had been banned. The story spread like wildfire, with conservatives decrying another salvo in the trans culture war, and British radical feminists claiming that trans women activists were trying to “erase women.”

However, the guidelines explicitly address the panic spread in the British and American conservative press. “Please note that these language changes do not apply when discussing or caring for individuals in a one-on-one capacity where language and documentation should reflect the gender identity of the individual,” reads the guidelines. “When caring for cis women it is good practice to use terminology that is meaningful and appropriate to the individual; this may include terms such as woman, mother or breastfeeding.”

The 2016 BMC study found that using feminine-coded words like she/her pronouns, “mother,” or “breasts” can sometimes trigger dysphoria in trans patients that identify otherwise. All 22 study participants referred to their upper torso area as their chest, avoiding the word “breasts.” 

The discourse over this language is a source of deep frustration for all of the people who spoke with Massive for this story. Loganov noted that they first heard the term chestfeeding around the time they stopped breastfeeding their child. “I would have appreciated knowing that terminology and using that terminology instead,” they said. “I always did feel disconnected from the word breastfeeding because I don't like any of the words for, whatever is up here, like breast. I hate them all.”

Rose thinks the online discourse over the language leaves a long term mark on trans people. “In the UK at the moment, I think there is a huge sort of anti-trans agenda,” he said. “There's no real consequences for newspapers and TV programs being transphobic. Someone will start a media storm about it for like three days and then it will be completely forgotten and a year later, no one even remembers it. But a year down the line, there's still trans people suffering because transphobia has been instilled in some people's minds.”

The language battle extends far beyond the word chestfeeding as well. Anti-trans activists have gotten upset over period products being marketed to “people who menstruate,” or maternal care providers referring to “pregnant people” rather than “pregnant women.”

Wilson said that such kerfuffles are merely designed to make trans men and non-binary people feel more unwelcome in accessing birthing and post-birth care. And she noticed previously welcoming breastfeeding spaces turn hostile in the US not long after former president Donald Trump took office.

During her research, which took place pre-Trump, Wilson marveled at how conservative women in the breastfeeding support movement wouldn’t hesitate to help trans men or lesbian couples who maybe weren’t producing enough milk. “They were affirming,” she said. But as trans issues came more and more into the forefront of politics — and by extension the culture war — Wilson said the tone began to change.

“Trump politics I think affected the way that people talk about breastfeeding too,” she said. “The rhetoric around it has gotten heated and it is definitely about like, ‘how can we make trans people feel more uncomfortable? Oh, we could do it here. Here's another way!’ Which was not what was happening before.”