Choosing how to feed your baby is a decision that comes with many complicated emotions. It can feel like there are a million factors playing at once, but ultimately your mental health should come first.
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Trans person of color chestfeeding their baby
Credit: Alex Dos Diaz

When I was pregnant with my now 1-year-old, I spent hours reading and watching content about chestfeeding. I sifted, endlessly, through images of moms who looked nothing like me. Though I did find some experiences from queer couples having children, the representation for transgender and nonbinary parents was few and far between.

Note: Chestfeeding is used in place of breastfeeding and is preferred by many cisgender, trans, and nonbinary parents. For more information, GLAAD.org breaks down inclusive language.

I ended up waiting until my baby was born to make the decision that they should be the one to take the lead. When they were placed on my chest, they immediately searched for and found my nipple. I knew then that it would be a long road before they decided to give up my milk. I put my child's wants and this form of need ahead of my own, forgetting that I still had autonomy over my body.

If you're feeling overwhelmed thinking about how you're going to sustain a new human's life, you are not alone. Here's what you need to know.

Remember—You Have Options and Get To Make the Best Choice for You

It can be daunting to hear doctors, lactation consultants, social media influencers, friends, and family telling you a million different things at once about chestfeeding. What can be hard to admit to yourself is that you are the one making this decision for your baby and yourself.

"Feeding directly at the chest is great for some people," says Moss Froom, a trans and queer centered, full spectrum birthworker. But there are more options. Whether you choose to chestfeed or feed them donated milk or formula using a bottle or supplemental nursing system (SNS) at the chest, know that your baby will get fed. "There are so many ways to customize baby feeding to suit your needs, and there's no one right way for everyone," says Froom.

Chestfeeding doesn't need to only rely on the parent who gave birth to the child, either. It's just as possible for parents of any gender to induce lactation. Some parents even choose to co-lactate, taking that pressure off of the birthing parent.

Choosing how to feed your baby is a decision that comes with many complicated emotions. It can feel like there are a million factors playing at once. "Lactation induction is a huge commitment with no guarantees about the outcome and it can be a very emotionally and mentally difficult process," says Froom.

Lactating Is Weird for Everyone, but Gender Dysphoria Doesn't Help

Dr. Anna Tubman, M.D., a family practice physician focused in the LGBTQIA+ community and an International Board Certified Lactation Consultant (IBCLC), says, "For any gestational parent, there may be pressure on how you're going to feed your baby. Plus, trans and nonbinary patients may also have varying levels of dysphoria relating to their chest." Gender dysphoria can be described as discomfort or extreme distress that happens between one's body and their gender identity.

I was surprised to find those first few months of chestfeeding were not horrible for me. I was spending skin-to-skin time with the most amazing new person, I wasn't pregnant anymore, and feeding my child gave my chest a purpose.

"Some parents may feel that the constant attention to their chests, and the level of sensation and sometimes pain, brings up feelings of gender dysphoria, depression, or anxiety. Then for others, chestfeeding can bring new meaning to their chests," Froom confirms.

Inducing lactation if you are someone who has had any surgical changes to your chest can come with its own set of difficulties when it comes to lactating. Dr. Tubman says, "There is more awareness happening among the surgery community that if the goal is for a patient to chestfeed—and this is the same concern for cisgender or transgender patients who have had a breast reduction or augmentation—there are ways that the duct and blood supply system can be maintained for patients to have success with lactating after surgery."

While chestfeeding was a relatively easy start for me, my relationship with my body began to shift around the six month mark. I was beginning to dread feeding, wishing that a bottle would magically appear instead of having to dissociate from my body for my baby to be nourished. Retrospectively, I realize that I could have listened to that wish and made the shift to formula and everything would have been perfectly fine. But I was (and maybe still am) a stubborn person who thought I needed to prove something, despite how weird and uncomfortable chestfeeding had become for me.

Binding While Lactating

A large contribution to my own mixed feelings around gender was related to the appearance of my chest. As the summer months approached, hiding under baggy hoodies and layers was less plausible. Having a visibly large chest was keeping me inside, not wanting to be perceived as female and then misgendered.

I decided to buy a binder in a larger size than I had worn before pregnancy. When it arrived, I excitedly shoved my shoulders through it and pulled it over my chest. Looking in the mirror, I felt relieved that it was possible for my chest to still appear somewhat flat with some assistance. I wore the binder all afternoon until I felt the tingling in my chest signifying feeding time. But the pain and discomfort only amplified.

Dr. Tubman says, "I always remind my patients that wearing a binder can cause compression issues, skin breakdown, and rib pain. Your skin is already a lot more sensitive and if your chest is leaking milk this creates a perfect environment for yeast."

Many gestational parents choose to wear sports bras, which are great as long as they are well-fitting. Just remember to wash them more frequently than you would if you weren't lactating.

"This is tough because compressing the chest may contribute to a reduction in supply or clogging of ducts," says Froom. "It can be more about the structure of clothes than about compressing to reduce the size of the chest. I always recommend overalls for a garment that obscures the size and shape of a chest."

Chestfeeding and Hormone Replacement Therapy

When I finally made the decision to wean my 11-month-old off my milk, my goal was to begin Hormone Replacement Therapy (HRT) in the form of testosterone as soon as I could. My desire for HRT had started a few years prior, and I made the choice to wait until after having a child to begin the process of medically transitioning.

That being said, this process can look different for everyone.

Some parents who have already been on HRT prior to pregnancy and chestfeeding may choose to resume low-dose testosterone with close monitoring of the hormone levels in their milk. According to the National Center for Biotechnology Information (NCBI), "Breastfed infants appear not to be adversely affected by maternal or transgender paternal testosterone therapy (100mg of subcutaneous testosterone pellets). High doses of testosterone can suppress lactation." 

"In general, the guidance of pregnancy and lactating is an awareness of mental health." says Dr. Tubman, "If someone is having dysphoria with lactation, we would make a decision based on their goals." Looking back, I do wish I had weaned my child sooner and begun HRT around the six month mark, when I began to experience growing dysphoria. If beginning or continuing HRT is what will be best for your mental health, speak with your doctor about your options. 

"A fed baby is a happy baby," says Dr. Tubman. And while the pressure to feed your baby one way might be overwhelming, your happiness and comfort is ultimately what will support your baby's positive growth and development.