January 19, 2023
By Jacqueline Truong, Drexel University College of Medicine
The term LGBTQIA+ represents our lesbian, gay, bisexual, transgender , queer/questioning, intersex, asexual communities, and more. By definition, “sex” refers to biological assignment of female and male, whereas “gender” refers to one’s personal and social identity. This key distinction is essential to understand and incorporate when addressing the concerns of our LGBTQIA+ patient population in the clinic and beyond.
Gender identity is decided by each person and is one’s own sense of feeling more masculine or feminine or somewhere in between. It is fluid and does not necessarily fall perfectly into the binary choices of ‘male’ or ‘female.’ As defined by GLAAD, “Transgender is a term used to describe people whose gender differs from the sex they were assigned at birth. For transgender or non-binary people, the sex they were assigned at birth and their own internal gender identity do not match.”
Research has shown that discrimination, transphobia and homophobia in the medical field are clearly evident, with many members of the LGBTQIA+ community often delaying or avoiding medical care altogether due to these societal barriers. Even when gender nonconforming patients do eventually seek out care, the challenges remain. Setbacks range from the inability to make an appointment, in the case of untrained receptionists believing a masculine voice calling for a prenatal appointment to be a prank call, to paperwork that uses exclusionary language such as “pregnant woman” or “she/her,” and untrained staff addressing transmasculine individuals as “ma’am” or “mommy.” Waiting rooms can often be an unwelcoming environment, as patients may face judgement via unwelcoming stares. There is commonly no art or literature that reflects the personal lived experience of a nonbinary or transmasculine pregnant person. Without proper training and education, providers may also be insensitive to gender dysphoria and the concerns that surround it and may instead instigate these feelings in patients.
Why Inclusive Language Is Important
Dr. Laura Dinour stated that “Heterosexual and woman-focused lactation language… can misgender, isolate and harm transmasculine parents and non-heteronormative families.” She advocates that a key part of celebrating all lactating parents is to “acknowledge that as our community continues to grow more diverse, so does the image of families and that of lactating parents. There are parents who do not fit into our cultural expectations of ‘man’ and ‘woman.’” Gender identity is often fluid, and individuals who identify as transmasculine can still have the desire to chestfeed and carry their own child in their uteruses. Birthing parents who do not identify as a woman exist and they may not resonate with terms like “breastfeeding” or “mom.” Language is powerful, as it can cause harm people and trigger feelings of gender dysphoria. But on the other hand, it can empower and help people feel more included.
Delmar Bauta, a first-generation Cuban American who uses they/them/elle pronouns, is a midwife and a parent. Delmar notes that many of the terms that are intrinsic to the lactation and human milk-feeding environment can be seen as very cis-normative and female-engendered, which can feel exclusionary or even trigger feelings of gender dysphoria. “This added stress can lead to poorer birthing experiences, less sense of bonding with the newborn, and increased mental health strain due to an apparent lack of support.” Statistics have shown that transmen who become pregnant are at an increased risk for depression and suicidal ideation, and subsequently have an increased need for mental health services.
Key Consideration of Gender-Affirming Therapy in Lactating Transmasculine Parents
The process of pregnancy and chestfeeding in itself can trigger feelings of gender dysphoria in transmasculine individuals as their body changes. In the process of transitioning, transmasculine individuals may have had chest masculinization surgery and/or been on testosterone therapy. Many of them stop hormone therapy during pregnancy and chestfeeding, though some may restart testosterone therapy postpartum while chestfeeding. This combination of the cessation of hormones and bodily changes from pregnancy can trigger gender dysphoria.
Lactating transmasculine parents may have a reduced milk supply depending on previous masculinization therapies. For example, milk-making tissue may have been surgically removed or damaged during chest masculinization surgery. It is also important to consider if a transmasculine patient wants to continue taking testosterone or binding their chest while chestfeeding, which may further decrease milk supply. This is because testosterone therapy interferes with the hormone necessary for lactation (prolactin) and can cause a significant decrease in milk supply.
However, taking testosterone would not prevent someone from using an at-chest supplementer and having a nursing relationship. Some patients who are unable to chestfeed due to insufficient milk supply may still want to latch their baby on their chest to bond with them. In this case, consider at-chest supplementer systems, which can give the sensation of bonding and at times can also stimulate the parent’s milk supply as the baby sucks on the chest and the body responds by producing milk.
How to Be Inclusive/Support the Community
Overall, it’s important to adopt gender-neutral/gender-affirming, inclusive language for inclusivity in the clinic and beyond. A lot of the stress gender diverse individuals experience in the clinic can be assuaged by being aware of our words. Things that can be done include being conscious of everyday parenting vernacular. Proper staff education and training can be done to recognize biases, and transition toward using non-discriminatory language and an awareness of patients’ pronouns. In the clinic, welcoming signage, inclusive forms, and non-gendered bathrooms are also beneficial. When seeing the patient, it is also essential to ask for consent before touching their chest, whether in an exam or helping to latch.
While the term “breast” may be anatomically correct regardless of biological sex, the genderification of this term may represent a negative connotation for transmasculine individuals who refer to that area as their “chest.”
Below is a list of alternatives to commonly used terms:
- Parents instead of mother/father
- Non-birthing parent instead of father
- Gestational parent or lactating person/parent or pregnant person or birthing person instead of mother
- Chestfeeding instead of breastfeeding
- Human milk or parent’s milk or expressed milk or father’s milk or simply milk instead of breastmilk
- Milk pump instead of breast pump
- Non-nutritive suckling or comfort feeding instead of non-nutritive breastfeeding
The gender-neutral words are endless, and if ever in doubt, the best thing to do is ask the parent. What do they expect their baby to call them and their partner? How do they plan to feed their baby?
By being conscious of our language and making these small changes, our clinic spaces become much more inclusive and welcoming for all of our patients.
- Bartick, Melissa, et al. “Academy of Breastfeeding Medicine Position Statement and Guideline: Infant Feeding and Lactation-Related Language and Gender.” Breastfeeding Medicine, vol. 16, no. 8, 2021, pp. 587–590., doi:10.1089/bfm.2021.29188.abm
- Caby, Emilia Mense. “Breastfeeding or Chest Feeding: Why Inclusive Language Matters.” Truly Mama, 6 Apr. 2021, trulymama.com/news/why-inclusive-language-matters/
- Gay & Lesbian Medical Association. GUIDELINES FOR CARE OF LESBIAN, GAY, BISEXUAL, AND TRANSGENDER PATIENTS
- Jackson, Jason. “Inclusive Lactation Care: Supporting All Parents in Their Lactation Journey.” Nationwide Children's Hospital, 25 Aug. 2022, nationwidechildrens.org/family-resources-education/700childrens/2022/08/inclusivity-in-lactation
- MacDonald, Trevor, et al. “Transmasculine Individuals’ Experiences with Lactation, Chestfeeding, and Gender Identity: A Qualitative Study.” BMC Pregnancy and Childbirth, vol. 16, no. 1, 2016, doi:10.1186/s12884-016-0907-y
- “Transgender FAQ.” GLAAD, 11 Jan. 2021, glaad.org/transgender/transfaq
- Dinour, Lauren M. Speaking Out on “Breastfeeding” Terminology: Recommendations for Gender-Inclusive Language in Research and Reporting. Breastfeeding Medicine. Vol. 14, No. 8. Published Online:10 Oct 2019. doi.org/10.1089/bfm.2019.0110