Belated thanks to those who responded supportively on Lactnet and
privately to my sharing of my case study paper of the detransitioned
woman who grieved her inability to breastfeed her baby. I do find it
disturbing that my paper received a response like that. I do not
believe that there is anything in it that is transphobic in any way or
harmful to transgender people- to the contrary, it highlights the very
poor health care that many transgender people (and detransitioners)
are receiving, the poor quality of research underpinning medical
treatment (specifically chest masculinisation surgery/mastectomy), and
the need for better emotional and health care support for trans and
detrans people antenatally and postnatally around breastfeeding and
infant feeding. Discouraging discussion of this issue is not
beneficial to transgender people. I think that everyone should be
concerned that organisations that purport to provide guidelines for
the medical treatment of people with gender dysphoria or who identify
as transgender do not suggest that the impact on breastfeeding of
chest masculinisation surgery (and the impact of not being able to
breastfeed) is discussed as a part of consent procedures. I think that
those who are truly concerned that these individuals receive good
health care should contact the relevant breastfeeding organisation in
your country and ask them to write to WPATH (and AusPath if you are in
Australia/PATHA if you are in New Zealand) asking them to amend their
guidelines to ensure that this is addressed. And (as noted in my paper
addressing sexed and desexed language in maternity) do what you can,
either at a policy level or in working with individuals, to ensure
that the health risks associated with incorrect sex markers in health
records is well understood- incorrect sex markers are documented as
compromising the health care provided to transgender people resulting
in misdiagnosis, missed diagnosis and delayed diagnosis, including in
relation to pregnancy care (eg
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7395710/ https://www.durham.ac.uk/research/institutes-and-centres/ethics-law-life-sciences/about-us/news/obstetric-violence-blog/trans-men-and-obstetric-violence/)
and is something that many trans men who have long experience of
living in a female body but appearing male are well aware of
(https://www.bmj.com/content/373/bmj.n1261/rr-20). I would suggest
that is a breach of medical ethics to permit alteration of sex markers
in health records. Karleen Gribble
Australia


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