Trans Healthcare Is Finally Getting the Scientific Attention It Deserves

In January, a study published in Transgender Health detailed treatment that successfully allowed a trans woman to breastfeed her child.

The woman had the goal of becoming the primary food source for her baby because her pregnant partner was not interested in breastfeeding. After three months of increased estradiol and progesterone, along with the use of a breast pump, she began to generate breast milk, eventually producing enough to feed her baby exclusively for six weeks.

The finding was picked up by many news outlets as a triumph of modern medicine. But while it may have struck some as cutting-edge, it could also be considered long overdue.

The study, authored by Dr. Tamar Reisman and nurse practitioner Zil Goldstein of the Mount Sinai Center for Transgender Medicine and Surgery in New York, marks the first formal report of such a case in medical literature. And it’s indicative of a new wave of advances in transgender reproductive medicine—as well as the ongoing need for more research in the area. Trans-specific medical studies have been severely limited until recent years, and there is still a dearth of medical practitioners well-versed in working with trans individuals.

Dr. Reisman says that, when it comes to transgender health, many patients “find it difficult to find providers locally who are knowledgeable.” She cited a 2016 study that found, through survey responses, that only 20 percent of endocrinologists were “very” comfortable discussing gender identity and/or sexual orientation with their patients; 41% felt “somewhat” or “very” competent in providing transgender care. And trans patients are often reticent to seek help from doctors that they view as unlikely to give them proper care. According to the 2015 U.S. Transgender Survey, nearly a quarter (23 percent) of respondents reported not seeing a medical professional when they needed to for fear of mistreatment.

To fill that need, trans communities have long relied on online forums, health guides, and word of mouth, for fertility and other hormone-related healthcare recommendations including breast milk induction strategies. For example, Brown Boi Project’s Freeing Ourselves: A Guide to Health and Self-Love for Brown Bois, is aimed at transmasculine and masculine-of-center people of color; and Trans Bodies, Trans Selves: A Resource for the Transgender Community, serves as a comprehensive health guide modeled after the groundbreaking Our Bodies, Ourselves.

As Reisman notes, however, the field of transgender medicine is growing rapidly. “There’s a huge paucity in the literature regarding trans medicine,” Reisman added, “and people are eagerly trying to fill in those holes. Everything you can think of is being studied.”

Reisman and her team at Mount Sinai recently submitted a request to the Institutional Review Board to look at breast development in trans women on different hormone regimens. Her team is also working with the radiology department to study breast cancer screening in trans women. Other researchers are focusing on subjects such as the long-term repercussions of hormones on fertility and cardiovascular health and the medical treatment for trans youth. The list goes on.

The reason there are so many new areas of study within transgender health research is because the topic as a whole has long gone scientifically untouched, particularly in the realm of reproductive medicine. The information, however, is critical in helping trans people make important medical and reproductive decisions.

It was long assumed, for instance, that long-term hormone usage would result in sterility for trans people of all genders. But more recently it’s been found that this is not necessarily the case; while rates of sterility may be higher among trans people who have undergone hormone therapy, many retain fertility for longer than expected, or regain it after going off hormones.

Advice on reproduction for trans women specifically has been especially hard to come by, making Goldstein and Reisman’s recent study particularly notable. Micha Càrdenas, a poet and scholar who’s written about her experiences with gamete banking, has even criticized Trans Bodies for centering transmasculine health and only briefly mentioning sperm banking as a possibility for trans women who want to have children. In her own reproductive pursuits, she has relied on other trans women for knowledge. In the notes on her poem “Pregnancy” she writes: “On a popular social media website, I found a closed group for trans women’s fertility. The group was small, with only eight members, about half of whom actively post. Yet it was here that I learned that I could simply buy a microscope to monitor my own fertility.”

Strategies like the one that Càrdenas used can reduce the cost of fertility care significantly. But it’s never cheap: gamete banking still costs anywhere from two to ten thousand dollars, and other fertility treatments are similarly expensive. As Goldstein noted, “We have to think about income inequality as well as trans inequality.”

As research in transgender medicine continues, the hope, Reisman says, is that providers will have more knowledge to work with. “Large, well-done studies typically happen within the context of large, well-funded academic institutions. So as transgender medicine moves to the academic sphere, I expect to see more and more data that helps us make sound clinical decisions.”

Since many reproductive interventions are not covered by health insurance, clinical advances must be coupled with advocacy work around access to healthcare, and increased coverage for specific procedures in order for trans patients to actually have more options. Still, these advancements are a necessary step in giving trans people more agency over their reproductive options. “We want everyone to have access to reproductive rights,” said Goldstein, “and the ability to reproduce if they so desire.”