Wednesday, May 09, 2018

Interesting Paper

I remember when I first went on hormones and I was taking progesterone and I started lactating… surprise!
Case Report: Induced Lactation in a Transgender Woman
Transgender Health
By Reisman Tamar  and Goldstein Zil
Published Online: 1 Jan 2018

Objective: Our report describes a case of nonpuerperal induced lactation in a transgender woman.

Methods: We present the relevant clinical and laboratory findings, along with a review of the relevant literature.

Results: A 30-year-old transgender woman who had been receiving feminizing hormone therapy for the past 6 years presented to our clinic with the goal of being able to breastfeed her adopted infant. After implementing a regimen of domperidone, estradiol, progesterone, and breast pumping, she was able to achieve sufficient breast milk volume to be the sole source of nourishment for her child for 6 weeks. This case illustrates that, in some circumstances, modest but functional lactation can be induced in transgender women.
It isn’t that hard to stimulate the milk ducts…
Previous investigators have reported the following basic framework for nonpuerperal induced lactation: (1) increased estradiol and progesterone dosing to mimic high levels seen during pregnancy, (2) use of a galactogogue to increase prolactin levels, (3) use of a breast pump with the speculation that it would increase prolactin and oxytocin levels, and (4) subsequent reduction in estradiol and progesterone levels, with the intention of mimicking delivery.
I find it amazing that we can do this and it shows that male and females are not that different.

There is a little difference in the milk…
One major difference between the induction of lactation in cis and transgender women is the need for androgen blockade in the latter group. Our patient continued to take spironolactone while breastfeeding for androgen blockade. A known metabolite of spironolactone, cancrenone is excreted in human milk. This has been shown to be 0.2% of the maternal daily dose, which is thought to be clinically insignificant. Spironolactone has been reported to have tumorigenic potential in rats, but according to the American Academy of Pediatrics, it is thought to be compatible with breastfeeding.
I wish that I knew beforehand that I could lactate because it wouldn’t have scared me when I saw a white discharge from my breasts.

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