Pregnancy and lactation involve two aspects that are socially and culturally associated with women. However, there are a few biological differences between male and female breast tissue.
Lactation and pregnancy are viable processes that do not depend on sex. Even for the latter, it is only necessary to have an organ capable of gestation. Ways to favor mammogenesis and lactogenesis in trans* women have been established. There are protocols to promote lactation in trans* women, usually used for adoptive mothers or those whose children have been born through gestational surrogacy. Chestfeeding a baby could be the cause of feelings as diverse as gender dysphoria in the case of trans* men, and euphoria and affirmation of femininity in trans* women. This study involves a review of the available scientific literature addressing medical aspects related to pregnancy and lactation in trans* individuals, giving special attention to nursing care during perinatal care. There are scarce studies addressing care and specifically nursing care in trans* pregnancy and lactation. Our study indicates the factors that can be modified and the recommendations for optimizing the care provided to these individuals in order to promote and maintain the lactation period in search of improvement and satisfaction with the whole process.
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The ability to induce non-puerperal functional breastfeeding has been previously documented. Most protocols are based on the protocol created by Jack Newman, a pediatrician and founder of the Newman Breastfeeding Clinic & Institute [
39,
40], so that Lenore Goldfarb, a ciswoman, was able to breastfeed her son born by gestational surrogacy. This protocol is included in his book titled “Newman-Goldfarb” [
41]. The text is based on the use of certain medications and breast stimulation. The expected outcome is to imitate the physiological development of the mammary gland during pregnancy, the progressive increase in serum prolactin levels after childbirth, and the stimulation and extraction of milk [
42,
43]. To that end, estrogenic therapy is complemented with progesterone and is responsible for the increase in duct branching and maturation [
1]. The following basic guideline for inducing non-puerperal breastfeeding has been reported: first, estradiol and progesterone are increased in a way that reproduce the high levels of pregnancy; then, a galactagogue, such as domperidone, is used to increase prolactin levels, together with stimulation produced by a breast pump. In parallel, there is secretion of prolactin, which plays a key role in mammogenesis, and oxytocin, which will favor the ejection of milk. Finally, the levels of estradiol and progesterone are reduced by mimicking the natural postpartum process [
23,
44,
45].
The United States government agency responsible for the regulation of food, medicines, cosmetics, medical devices, biological products, and blood products (Food and Drug Administration—FDA), considers the current use of domperidone an effective galactagogue,
posing unknown risks to infants* [
46]. In this sense, the study conducted by Reisman and Goldstein in 2018 indicated the effectiveness of domperidone in a trans* woman in achieving milk secretion together with the use of a breast pump [
23].
*and that's with biological females