Male Lactation: The New Frontier in Evidence Laundering

The justifications given for inducing lactation in males are not grounded in evidence, but relate entirely to the imagined need to “affirm” their female gender identities.

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About the Author

Carrie Clark is a writer and researcher from the UK. Her work focuses on freedom of speech, viewpoint diversity and classical liberalism as natural antidotes to the capture of institutions by dogmatic ideologies. Her reports are available at the Free Speech Union and Don’t Divide Us, and her articles are available on spiked. She is proud to have co-authored the Genspect FAQ with Helen Pluckrose and Stella O’Malley. Her report on politicized policing was featured in the Times and her research on viewpoint diversity in libraries was covered by the Telegraph and the Daily Mail. Follow her on X @cwestonclark.

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I’ve spent the last four years researching and writing about the gender wars, and the grisly nature of sex change surgeries such as penile inversion and double mastectomy presents a potentially fertile ground for feelings of disgust. These procedures require a strong stomach to look beyond instinctive revulsion and ask, “What does the evidence actually say about this?” But this is necessary if we’re serious about moving beyond emotive talking points and restoring the reputation of evidence-based medicine.

As it happens, I generally feel no more disgust toward mentally competent adults undergoing sex change surgery than I do toward those getting breast augmentations or Brazilian butt lifts. While it saddens me that some people feel the need to have these radical cosmetic procedures, my sensitivity to disgust remains low as long as we’re discussing consenting adults. However, there’s one aspect of the gender wars where I’ve struggled to overcome a visceral sense of moral disgust: transwomen (i.e. men) breastfeeding babies. Each time I encounter a story a story on this topic, I feel profoundly queasy. Words like “violation,” “abhorrent,” and especially, “UNNATURAL” erupt from my subconscious, while my conscious mind struggles to make rational sense of what I’m seeing or reading.

But what does the evidence actually say?

With my palms sweating and my stomach churning, I’ve tried to find out, and I’m afraid it doesn’t look good. The literature on lactation induction in trans-identified males seems poised to replicate the scandalous evidence laundering exposed by the Cass Review, characterized by low-quality research that barely qualifies as anecdotal being accepted into standards of care and national guidelines without adequate scrutiny. Scrupulous adherence to the religious-like tenets of gender identity ideology has prevented researchers from addressing fundamental issues, such as the physical differences between male and female bodies or the impact of elevated testosterone levels on infants fed with male lactate. Most troubling is the progressive reluctance to acknowledge has lead researchers to ignore well-documented differences in the expression of male and female sexuality, exposing children of transitioners to serious risks of exploitation and abuse.

An unexamined feeling of disgust is a poor guide to whether something is morally right or wrong, as seen in historical bigotry against same-sex attraction. Upon closer examination, what often appears as moral disgust may actually be prejudice against difference, not an infallible moral intuition about the nature of right or wrong. However, we should not disregard our moral intuitions altogether. Sometimes, as in the case of transwomen breastfeeding, the evidence backs up what our instincts are signaling.

Evidence Laundering: How Bad Research Becomes the Gold Standard

A scoping review published in April 2024 identified just 21 papers on the subject of lactation induction in transwomen. Six of these are individual case reports in which medical professionals induced lactation in a transwoman by adapting protocols originally developed for inducing lactation in non-gestational (but nonetheless biologically female) parents. Some of these case reports are behind a paywall, but they failed to collect data on a standardized set of comparable variables or to conduct follow-up assessments longer than nine months for either the transwomen who induced lactation or the infants they breastfed. It’s striking that, in many of these case reports, the wellbeing of the baby is barely mentioned, with crucial details such as the child’s sex, weight, and other vital signs not recorded by researchers. Only the 2018 Reisman Goldstein study, the best-known case report on lactation induction, briefly mentions that a pediatrician described the child’s progress as “developmentally appropriate” in the first six weeks.

These six non-comparable and severely limited case reports appear to represent the totality of evidence supporting lactation induction in transwomen. Nonetheless, an additional 11 papers identified by the scoping review—comprising guidelines, standards of care, and reviews—rely on these six inadequate case reports to advise clinicians that inducing lactation in transwomen is safe and should be made routinely available. Although data on the prevalence of this practice are unavailable, anecdotal reports abound. In the UK, several NHS trusts explicitly recommend it.

Additionally, three papers identified by the scoping review are news coverage or opinion pieces about the Reisman Goldstein study, while one is merely a survey that asked members of the World Professional Association of Transgender Health (WPATH) if there was a demand for lactation induction among their transgender patients. It should go without saying that just because there is demand for a given medical procedure does not automatically justify its provision. If the experiences of detransitioners have taught us anything, it should surely be that.

Those who’ve read the Cass Review might recognize this circular process of so-called “evidence laundering.” The Review found that the use of puberty blockers and cross-sex hormones in gender distressed youth was based on remarkably poor evidence of safety or efficacy. Nevertheless, guideline creators like WPATH and the Endocrine Society still recommended widespread access to these experimental interventions. The proliferation of national guidelines and standards of care that simply echoed WPATH recommendations wholesale created what Cass called “an apparent consensus on key areas of practice despite the evidence being poor.” Future standards of care produced by WPATH were then able to cite those national guidelines as though they represented new, independent evidence supporting “gender affirming” medical interventions. With few exceptions, the Cass Review demonstrated that virtually all existing guidelines were merely reiterations of the same discredited evidence originally misrepresented by WPATH and the Endocrine Society.

Institutions ideologically captured by gender identity theory are replicating this process of evidence laundering to promote the practice of inducing lactation in transwomen. The attitude of the scoping reviews authors’ is typical. Despite concluding that “Evidence on lactation induction for transfeminine people is scarce, fragile, and recent” and that “The literature about lactation induction in transgender women provides little evidence-based material to support this demand,” they go on to recommend that it be made available as standard practice: “The non-recommendation of the practice…can reinforce inequities and barriers to health access for this population [transwomen], since the same questions and concerns are not applied to the milk and breastfeeding of cis women.” According to this account, avoiding any appearance of “transphobia” or “cisnormativity” is more important than ensuring that radical medical interventions are performed on the basis of strong evidence of benefit and a careful assessment of risks.

Ideology before evidence. Sound familiar? By now it should to anyone familiar with the gender wars. Thanks to the Cass Review and Mia Hughes’ groundbreaking work on the WPATH Files we now know that the entire edifice of so called “gender affirming care” perches precariously atop a set of fixed, ideological beliefs. These include the notion that a person’s “gender identity” is more important than biological sex, that opposition to the medicalization of gender-distressed people is “transphobic,” and that any evidence to the contrary can be safely ignored or dismissed as bigotry. Evidence laundering is dangerous and antithetical to good science, as the unfolding medical scandal around “gender affirming care” has already clearly demonstrated.

Queer Cavemen: Putting Ideology Before Evidence

Above I mentioned some of the entrenched ideological beliefs that underpin “gender affirming care.” The refusal to abandon these beliefs, despite overwhelming contrary evidence, has caused much of the harm arising from gender medicine. One such belief features prominently in the literature on lactation induction: all six case reports appear to proceed from the belief that transwomen, or biological men, are exactly analogous to biological females in all respects. Some scholars even resort to revising evolutionary history in innovative yet implausible ways to forestall any common sense interrogation of whether this is actually the case.

Consider the set of 2019 Canadian guidelines titled “Lactation Care for Transgender and Non-Binary Patients: Empowering Clients and Avoiding Aversives.” These guidelines portray male breastfeeding as a social norm that was unjustly eradicated by bigoted colonialists:

[O]ne could be forgiven for assuming that TGNB [Transgender and Non-Binary] lactation is an exotic frontier. Yet, approaching our health needs from this perspective is inherently “othering” and also inaccurate. Cultures from around the world and across time have been documented to include people with diverse gender identities…who participate in varied activities to do with work, spirituality, and family life.

“Varied activities” is doing a lot of heavy lifting in this sentence, hinting that historically, trans identified males were commonly found breastfeeding babies on every second street corner. However, the tiny number of poorly verified accounts of males with pituitary disorders breastfeeding infants in life or death circumstances do not amount to conclusive proof that ancient societies regarded breastfeeding as a gender neutral activity. We simply have no evidence that queer cavemen regularly popped home from the sabre-toothed tiger hunt to breastfeed their newborns.

Recall that these are not a whacky musings of a dissertation by an overenthusiastic queer theorist, but rather a set of medical guidelines published by the National Library of Medicine. These guidelines are intended to support clinical decision-making. Yet, the paper’s introduction whimsically concludes—without any supporting evidence—that “It is likely that the history of TGNB [Transgender and Non-Binary] lactation is as ancient as the human species itself.”

For those of us not entirely convinced by this assertion, the fact that both male and female bodies are theoretically capable of lactating does not necessarily imply that they do so in the same way, or that the lactate they produce is identical in composition. Similarly, both men and women are capable of having heart attacks, but there are well-established sex based differences in the symptoms they experience and the treatments they respond to. Nevertheless, the entire literature on lactation induction in transwomen proceeds from the fixed ideological belief that there is no difference between an estrogenized male and a biological female. The following passage from the Reisman Goldstein case study is typical in assuming from the outset that all the benefits of female breastfeeding automatically apply to men as well. It even goes so far as to imply that breastfeeding can reduce the risk of trans identified males contracting ovarian cancer. Given that they do not have ovaries, this is a particularly bizarre claim to see in a medical paper:

Breastfeeding offers immunological, metabolic, and psychosocial benefits for both mother and infant. Breast milk contains secretory IgA, anti-inflammatory agents, and other immunomodulators that give breastfed infants immunological advantages relative to formula-fed infants…Women who breastfeed are noted to have lower rates of…ovarian cancer than women who have never breastfed.

There is, of course, no systematic evidence showing that the “immunological, metabolic, and psychosocial benefits” of female breastfeeding also apply to male lactation, or that “breast milk” produced by trans identified males “contains secretory IgA, anti-inflammatory agents, and other immunomodulators” in the same way as breast milk from females. One does not need to be a medical practitioner to understand that the first question clinicians should have asked when confronted with trans identified males wishing to breastfeed is whether the differences between male and female bodies would produce differences in lactate. I cannot overemphasize the extent to which this entirely commonsense question is completely ignored in the existing literature.

In fact, the only acknowledged difference between trans identified males in the research is that trans identified males take cross-sex hormones. However, even though this is acknowledged, it is nowhere treated as particularly relevant or significant. One case report briefly mentions the “management of gender-affirming hormone therapy” as a “unique consideration,” but only as a secondary matter. Instead, the primary focus is described as “the need for appropriate and affirming language.”

Similarly, the off-label use of the non-FDA approved drug domperidone, which the literature assumes must be safe for use in biological males based on the highly unpersuasive basis that it is deemed safe for use in “non-gestational parents” who are nonetheless biologically female, is likewise treated as inconsequential. Staggeringly, the Reisman Goldstein study was conducted using domperidone obtained by the patient over the internet. In a particularly egregious example of disregard for basic research protocols, the clinicians failed to verify the source of the substance or confirm its authenticity. Only one of the six case reports includes a macronutrient analysis of the lactate produced. As a result, it is unclear whether lactate from estrogenized males treated with domperidone is either nutritional or safe for infant consumption.

Dr Maja Bowen, a retired medical doctor and author of the book Born in the Right Body, has authored a detailed analysis of the medical risks associated with transwomen breastfeeding. She highlights the potential harms done to female infants by the elevated levels of testosterone in male lactate. As it stands, “gender affirming” clinicians have shown no interest in either understanding or preventing these harms, and medicine cannot be practiced safely in an environment where clinicians prioritize the protection of their dogmatic ideological beliefs over the protection of patients.

Won’t Somebody Think of the Children? Physiologic Autogynephilia and Other Uncomfortable Facts

The erosion of child safeguarding is a disturbing feature of so-called “gender affirming care.” This includes sterilizing hormone treatments administered before a child can fully comprehend the lifelong implications of infertility and sexual dysfunction, and greenlighting mastectomies and vaginoplasties for young people with multiple untreated mental health conditions. Clinicians practicing “gender affirming care” have never shown much regard for the safety and wellbeing of children. Moreover, I am truly shocked by the blatant disregard for the rights of infants in the literature on lactation induction. The helpless newborns fed on untested, chemically induced male lactate are virtually invisible in the evidence I’ve reviewed.

This oversight is perhaps most apparent in the rationales provided by the literature supporting lactation induction in trans-identified males, where I naively expected a focus on the impact on newborns. How wrong I was. Apart from the unsupported claim that infants breastfed by trans-identified males will benefit from the psychosocial and immunological advantages associated with traditional female breastfeeding, the justifications given for inducing lactation in males relate entirely to the imagined need to “affirm” their female gender identities. One study argues that “breastfeeding is part of the female gender experience” and should, therefore, be available to trans-identified males, while another study describes male lactation as “a profoundly gender-affirming experience.”

It will be many years before the generation of newborns currently being breastfed by their trans-identified fathers can speak for themselves. However, adult children of transitioners are overwhelmingly opposed to the practice. They remain a largely invisible group, rarely given a platform to speak about the complex emotional impact of witnessing a parents’ transition, unless it is to celebrate and “affirm” the parent’s adoption of a trans identity. Given the consistent disregard for the rights of the child that I have observed in the literature on transgender lactation, I feel their concerns deserve to be quoted here at some length.

The following quote is taken from a letter authored by the much-needed British campaign group Children of Transitioners (CoTs) to the NHS practitioners who facilitate lactation in trans identified males:

We understand some NHS Trusts are now seeking to enable and enforce the sexual and emotional abuse of children who are CoTs [children of transitioners], and are introducing policies that not only fail to safeguard these children…but also actively encourage the sexual assault and grooming of vulnerable babies and children who come into contact with NHS staff. Some of our dads ‘transition’ for sexual reasons, and many just change their clothing choices or have breast implants. CoTs’ still have both the legal right and the emotional need to be safeguarded by NHS staff – just like all other children…We have seen evidence that some hospital Trusts are making children of transitioners suck their father’s nipples- an act of sexual assault and grooming that deeply shocks us as NHS staff should be protecting COT infants not enabling their abuse…We have no idea of how many NHS Trusts are doing this. It fails to consider the health, welfare, and safeguarding of children of transitioners. It encourages our fathers and other men to feed children like us, as babies, drug induced secretions from their bodies and to commit, and groom us for, sexual assault.

These are strongly worded and emotive claims but are supported by a growing number of clinicians and commentators who recognize the role of “autogynephilia,” or transvestic fetishism, in many cases of male-to-female transition. Transvestic fetishism is listed as a “paraphilia” in the current Diagnostic and Statistical Manual of Mental Disorders, indicating a sexual compulsion to dress, act, and be perceived as the opposite sex. Although research on autogynephilia is limited, sexologist Ray Blanchard identified four distinct subtypes of this fetish, including “physiologic autogynephilia”—male sexual arousal at the thought of possessing female bodily functions. This type of autogynephilia might explain why some trans-identified males desire to use or carry menstrual products they do not need, or why they fantasize about experiencing menstrual symptoms, despite this being physically impossible. Troublingly, it also seems to explain why some trans-identified men are willing to go to extreme lengths to induce lactation. Take this disturbing quote from Dana Fried, a transwoman writing in The Stranger in 2017:

Breastfeeding is freaky. Not the sucking bit. You’re reading The Stranger, so odds are you’ve had a titty sucked at some point in your life. No, it’s because when my baby attached to my breast, there was an incredible chemical cascade that ran through my entire body like lightning. Imagine the most electric thing a partner has ever done to you, then multiply it by 10…(And yeah, I kind of got off on it. Don’t judge.)

How is Fried’s daughter likely to feel when she learns that her father likened the experience of breastfeeding her to engaging in foreplay with a sexual partner? What will she make of the medical professionals who enabled her father to exploit her instinctive newborns’ urge to suck at a breast for his own sexual gratification? It’s difficult to articulate just how deeply unsettling and destabilizing it will surely be for children of transitioners to realize that they were a “gender affirming” prop in their parents’ autogynephilic sexual fetish before they could even walk or speak.

I want to be fair here, so I need to note that cisgender women also sometimes report experiencing sexual arousal when they start to breastfeed. In women, breastfeeding is known to release the hormones oxytocin and prolactin, which are associated with sexual intimacy and orgasm. However, there is a powerful qualitative difference in how men and women describe this difference, aligning exactly as we would expect with the profound differences between male and female sexuality.

Breastfeeding forums for women overflow with comments from concerned women wondering if their sex drive will ever return, indicating that lactation is most strongly correlated with an absence of sexual desire among new mothers. Common post titles include things like “No Sex Drive,” “Not feeling sexual while BFing [breastfeeding],” and “major lack in sex drive.” There is no evidence that women are actively seeking to lactate in order to experience sexual arousal. On the contrary, many advice guides for new mothers aim to alleviate feelings of embarrassment and shame, reassuring women that experiencing such biological responses is not deviant. By contrast, Reddit hosts a number of concerning channels, such as “Forbidden Lactation” and “Male Lactation Fetish,” where trans-identified men cheerfully swap fetishistic fantasies about pregnancy and breastfeeding. Consider the following comment from a Reddit user, and decide for yourself whether the author is more likely to be male or female:

I remember watching breastfeeding tutorials in my early teen years because ‘I got off to it’…I also have this pregnancy and breeding kink. I’ve fantasized about being bred or being pregnant.

Conclusion

Hopefully you’ve mastered your instinctive feelings of disgust after reading those horrifying quotes (and they’re really, really disgusting so I understand if you need a moment). Now, let’s return to the facts and attempt to answer that essential question we began with: What does the evidence say?

Unfortunately, there isn’t much evidence, at least not quality evidence. The safety of male lactation remains an open question, and the existing literature fails to reckon the clear differences in attitudes toward breastfeeding between males and females, especially considering the influence of physiological autogynephilia. Disgust aside, these facts logically point to some obvious safeguarding considerations that are not addressed by current research. My impression is that addressing these issues would undermine the entire ideological foundation of “gender affirming care,” and that’s one of the primary reasons why researchers looking at lactation induction have simply avoided these topics.

It is undeniable that men are responsible for the vast majority of sexual offenses, and that women are overwhelmingly the victims of these crimes. Paraphilias, including autogynephilia, primarily occur in men and are known to cluster, meaning a person with one paraphilia is likely to have others. Many unethical sexual practices, such paedophilia, zoophilia, voyeurism, and exhibitionism, are paraphilic in nature. People with multiple paraphilias are known to be at higher risk for sexual offending, although it’s important to note that having a paraphilia is not a prerequisite for sexual offending: many people with paraphilic sexual interests commit no offences at all, while the majority of convicted sex offenders are not diagnosably paraphilic. We are talking about statistical averages here, which do not apply to individuals but should certainly inform policies that are implemented at the population level, such as medical standards of care.

When a clinician is approached by a trans identified male who wishes to breastfeed, it is an unfortunate statistical fact that they are more likely to be looking at an individual with a paraphilic sexual disorder than they would be if the patient were female. If they agree to assist that patient induce lactation and breastfeed a child, they will be doing so on the basis of just six methodologically flawed case studies. Five of these studies did not analyze the composition of the produced lactate, and none sufficiently addressed the short- or long-term impacts of male breastfeeding on the child's well-being. Given that there are no circumstances under which it could reasonably be considered “medically necessary” for a man to breastfeed, and since we cannot currently differentiate between trans-identified males who wish to breastfeed for sexual gratification and those who genuinely want to bond with and nurture their child, it seems morally indefensible to allow the practice at all.

However, the first objection—that the current evidence doesn’t support the safety of the practice—doesn’t represent a durable and lasting argument against allowing transwomen to breastfeed. If consumer demand exists, which it undoubtedly does, America’s for-profit medical system will eventually find a way to make it safe. While lactation induction in trans identified men is unquestionably another example of the ideologically motivated laundering of inadequate evidence that has made “gender affirming care” the medical scandal of our era, I believe the existence of physiologic autogynephilic fetish among some transwomen wishing to breastfeed forms the strongest basis for opposing the practice. We need to shift the focus of this conversation toward the rights and experiences of children of transitioners, recognizing that their autonomy and right to an open future should always take precedence over the desires of their trans-identified parents to be “affirmed.” While not all trans-identified men seeking to breastfeed will be doing so for sexual reasons, public policy simply cannot distinguish between those who are predatory and those who are not.

I was prompted to write this article after reading a series of social media posts by the excellent feminist academic Dr Jane Clare Jones. Articulating John Stuart Mill’s harm principle, she wrote:

I don’t care what people are disgusted by. Many people are disgusted by men fucking each other. Some people are disgusted by interracial relationships… Moral disgust is not a legitimate basis for political action and not a legitimate basis for censuring anyone's behaviour. I don't care what people are disgusted by…I care what causes harm…It’s a case of looking at the disgust and working out if there is an account of actual harm on which to ground your argument and then grounding it on that and not on the disgust.

I couldn’t agree more. My instinctive moral disgust at the thought of trans-identified men breastfeeding is not, by itself, a legitimate basis for political action or for censuring anyone’s behavior. Moral disgust should serve as a jumping off point, not a foregone conclusion. An evidence-based approach can help us avoid prejudice getting the better of us by aligning our instincts with a clearer understanding of reality. The evidence suggests that opposition to transwomen breastfeeding isn’t merely transphobia or bigotry disguised as moral disgust. Like so much of “gender affirming” medicine, lactation induction in trans-identified men is ethically complex and under-researched, raising issues around sex, childhood, consent, and parenting that many people are understandably reluctant to engage with.

For the sake of children of transitioners, we need to overcome that reluctance.

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