CDC’s ‘chestfeeding’ guidance isn’t based on ‘bad science.’ It’s based on no science at all.

Chestfeeding. Bodyfeeding.

These terms have recently emerged as alternative names for breastfeeding in the ever-changing lexicon of our brave new world. But in reality, women can conceive babies. Women can breastfeed. Men can do neither. These weren’t controversial statements at any point in history, yet they’re presently considered up for debate, or even deemed hateful or harmful to individuals suffering from gender dysphoria.

In the last year, reputable medical organizations that once prided themselves on presenting evidence-based medicine have adopted language aimed at inclusivity but which is unmoored from basic biology and objective reality. 

The latest example is “chestfeeding” guidance issued by the Centers for Disease Prevention and Control (CDC). The guidance could theoretically apply to biological women who have had their breasts removed or significantly reduced, which makes lactation very difficult, or to individuals who believe themselves to be neither male nor female. But it’s most applicable to biological men who identify as transgender women and want to breastfeed (or “chestfeed”) the children they’ve adopted or who were carried by their female partners or surrogates.

The CDC has been castigated for irresponsibly ignoring likely health risks to infants, particularly from powerful medications taken by the biological males seeking to feed them. Critics insist that artificially-induced “nipple discharge” cannot come close to providing the health benefits true breastmilk confers on babies. 

The CDC’s new guidance is found on two web pages

The CDC’s website contains two references to transgender individuals attempting to breastfeed. The first is on its Health Equity Considerations webpage, which reads:

• Transgender and nonbinary-gendered individuals may give birth and breastfeed or feed at the chest (chestfeed). The gender identity or expression of transgender individuals is different from their sex at birth. The gender identity of nonbinary-gendered individuals does not fit neatly into either man or woman.

• An individual does not need to have given birth to breastfeed or chestfeed.

• Some families may have other preferred terminology for how they feed their babies, such as nursing, chestfeeding, or bodyfeeding.

And according to the CDC’s Breastfeeding webpage, the answer to the question, “Can transgender parents who have had chest surgery breastfeed or chestfeed their infants?” is yes.

“Some transgender parents who have had breast/top surgery may wish to breastfeed, or chestfeed (a term used by some transgender and non-binary parents), their infants,” the guidance reads, pointing out that such parents may require assistance with “Maximizing milk production, Supplementing with pasteurized donor human milk or formula, Medication to induce lactation or avoiding medications that inhibit lactation, Suppressing lactation (for those choosing not to breastfeed or chestfeed).” 

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Where did the CDC’s recommendations come from?

The primary scientific source material for the CDC’s new guidance appears to be a 2020 document from The Academy of Breastfeeding Medicine, which relied on exactly one case report plus anecdotal evidence to make recommendations about inducing lactation in biological males. Keep in mind that a case report reflects the experience of one, just one, patient.

In any other area of medicine, basing recommendations for a whole portion of the population on just one person’s experience would be unthinkable, the height of medical irresponsibility. 

The ABM statement reads in part, “There is one case report and many anecdotal reports of trans women inducing lactation (see Induced Lactation and Colactation section) and producing human milk.” The guideline notes, “In addition, there is no published research on the frequency of success [in inducing lactation in biological men].” Furthermore, the statement reads “There exists no standard guidance on inducing lactation for any patient population.”

Why might inducing lactation in men be harmful to infants?

Men do not naturally lactate, outside of extraordinarily rare instances such as a pituitary tumor or starvation or as a side effect of certain drugs like the heart medication digoxin that might possibly stimulate lactation, as described in this 2007 Scientific American article. As this article explains, there are two primary reasons for this: males have inadequate prolactin levels and inadequate development of mammary (breast) tissue during puberty. 

Men who desire to breastfeed have to take powerful medicines daily for months to induce lactation, and those medicines may harm the babies who consume their milk.

One such medicine is spironolactone, which is normally prescribed for heart and blood pressure problems. In men with gender dysphoria, it’s given off-label because it blocks male sex receptors, which leads to feminized appearance. Spironolactone has a long list of potential side effects for adult users, some of which can be serious. Its effects on breastfed infants have been studied almost not at all. 

Another medicine mentioned in the case report ABM referenced is anti-nausea medication domperidone. Because it also increases prolactin, the hormone responsible for breast milk production, domperidone has sometimes been used off-label to induce lactation in women, as for adoptive mothers who seek to breastfeed or mothers who stopped breastfeeding and want to restart. 

Domperidone is not FDA-approved for any reason in the U.S., according to the National Institute of Health’s (NIH) Lactmed database, which analyzes medication safety during breastfeeding. Domperidone was taken off the market in the U.S. in 2004 specifically because “[t]he serious risks associated with domperidone include cardiac arrhythmias, cardiac arrest, and sudden death.” In 2004, the FDA wrote, “Because of the possibility of serious adverse effects, FDA recommends that breastfeeding women not use domperidone to increase milk production.” 

Just how much domperidone might cross over into breastmilk?

No one knows. A 2021 case report cited in the Lactmed entry for domperidone involved a biological male taking domperidone off and on for nine months. Two other case reports cited in the Lactmed entry, including the one mentioned in the ABM statement, similarly reflected multiple months of domperidone ingestion. As purported proof that domperidone wouldn’t meaningfully impact breastfed infants, Lactmed cited a 2008 research study with a very small sample size, which found miniscule concentrations of domperidone in the breast milk of mothers who took it due to insufficient milk supply. But those mothers’ milk was tested after taking the medication for just a few weeks.

A Daily Signal article pointed out the hypocrisy of the CDC’s cavalier attitude towards parental ingestion of medications which are certain to end up in any breast milk they produce, even as pregnant mothers are told to avoid eating deli meats, soft cheeses, and other uncooked foods that could possibly contain listeria, which can in very rare cases be harmful or even fatal to a baby in utero. The article quoted a Twitter user who questioned, “So don’t eat sushi or lettuce or deli meat, but men can take a boatload of meds and make an infant drink their toxic chest discharge?” 

How does male breast milk compare to female breast milk? 

The short answer to this question is that we don’t know. The Lactmed entry for domperidone references the same case report from the ABM document, plus two others of biological men who produced breast milk. While the ABM-cited case report and one other did not analyze the breast milk for nutritional quality, the third Lactmed-cited case report did. According to the report, which is behind a paywall and was written by a California doctor who co-founded UCLA’s Gender Health program, monthly tests of the macronutrient (fats, carbs, protein) content of breast milk from one biological man with induced lactation were similar to a biological woman’s. (Of note, that individual was only ever able to produce very small quantities of breastmilk, which dwindled to a teaspoon per day after six months.) 

Mothers’ naturally-produced breast milk has incredible benefits for babies

Even the ABM statement admitted that a woman who gives birth to a baby is best suited to make breast milk specific to that baby’s unique nutritional needs: “When possible, consider prioritization of colostrum feeding with the gestational parent, given the individuality of colostrum for the neonate.” 

Sen Roger Marshall of Kansas, a retired OB/GYN with 25 years of experience, stated in a press release, “Colostrum is Mother Nature’s nutrient dense, real mother’s milk loaded with antibodies and antioxidants that gives a moms’ protection to the vulnerable newborn.” Marshall opined, “… the liquid produced by biological males will not provide all the nutrition or calories healthy, growing newborn babies need.” He continued, “A biological male filled with hormones and a concoction of other drugs that have not been studied that could harm a baby should NEVER be encouraged.” 

Even beyond that early colostrum, a mother’s breast milk retains near-superpower qualities, so much so that it’s considered a living substance. As this article from Natural Womanhood explains, a mother’s breast milk is “quite literally always changing, in response to all sorts of different factors. Practically, it also means that the milk a mom makes at 2pm on a Tuesday is constitutionally different from the milk she might make 24 hours, 2 weeks, or 6 months later.”

Fascinatingly, “the breastmilk a mom makes when her child is sick has more infection-fighting cells than when her child is well. And these changes and adaptations in breastmilk composition continue for as long as the mother breastfeeds.”

The CDC’s latest guidance on “chestfeeding” is in keeping with a mistaken general societal belief that adults have a ‘fundamental right’ to have children, without regard to how those children are conceived, what’s done with “excess” from assisted reproductive technologies used to conceive them, or the effects on those children down the road.

Sadly, the discussion over transgender-identifying individuals’ ability to chestfeed also fails to take into account the wellbeing of children. Children deserve better than to be treated as pawns or props to meet the desires of the adults who conceive or otherwise raise them.