I have been contacted via phone by a male to female transsexual.  She is 50
years old and has been on hormones for about 1 year.  She takes Premarin 2.5
twice a day  (was 2.5 once a day) and Progestine 30 mg in the morning and 20
in the afternoon.  Her prolactin levels 3 months ago were 36 ng, She was
told by her endocrinologist that this was a high level, that normal was 18 -
20 and that she might expect some lactation at this level.  She did some
reading about induced lactation and decided she wanted to attempt to bring
in a milk supply for a short time.

She has 2 reasons for wanting to attempt to induce lactation.  The first
reason is to elongate her relatively flat nipple and enlarge her relatively
small areola.  The second reason is psychological.  She feels she would feel
"more like a real woman" if she was able to produce milk.   There is no baby
involved.  At the time she called me she was already pumping for 3 days
using a small, battery powered pump that was not self cycling.  She was then
obtaining a teaspoon or so of yellow fluid each pumping session.  We talked
a while and I did not feel she was a person trying to pull a joke on me.  I
felt she was sincere in wanting this confirmation of her female nature. Her
doctor is aware of her plans and does not oppose them.  I decided I would
proceeded to give her what advice I could after sharing that I have had no
experience in this area am generally poor in knowledge of endocrinology
anyway.

It is with her permission that I am posting here.  Many questions come to
mind but the biggest questions are:
1) have any of you worked with a similar situation, if so can you share the
information, either privately or on lactnet as to the presentation and the
outcome and what was done to get to the outcome?
2) if you have not actually worked with such a situation do you have any
words of advice based on your knowledge of transsexuals or endocrinology?

I also asked her if she would be interested in donating any milk she obtains
for research purposes and she would like to do that.  Is anyone interested
in obtaining this milk for research?

So far I have advised her to:
1) consider the negative side of her plan to induce lactation, listing
possible complications she would likely never experience otherwise.  This
list includes; plugged ducts, mastitis with possible antibiotic treatment,
abscesses with possible surgery, extreme involution, soreness, minimal
success for the effort extended, need to wean slowly from the pump if she is
successful and ductal yeast.
2) she still planned to proceed so we discussed my best GUESSES on the
safest and most effective way to do so.
  A) switch to a self cycling pump (I think she was pushing it too long
prior to releasing the suction on the      other pump),
  B) limit sessions to 10 -15 minutes,
  C) aim for at least 6 session and 100 minutes per 24 hours, with 8
sessions being optimum,
  D) pump at least once during normal sleep cycle,
  E) use lansinoh to treat the dryness she described.
3) I also discussed the wide range of "normal" in nipple length and areolar
diameter in women.  She feels her nipple/areolar are very "male" looking
because the nipple is flat and the areola is small.  I told her areolas tend
to widen in pregnancy more than in lactation and that flat nipples tend to
raise up during pumping only to quickly return to a flat state afterwards so
I didn't **think** pumping would permanently impact on them but that what
she is describing fits perfectly well in the wide range of normal looking
nipples and areolas that I have observed.
4) She discussed things that she does that really push the physiologically
safe limit of pumping;  holding the suction for 45 seconds before releasing,
having a high tolerance for pain and ignoring pain, pumping 20 minutes per
side, have little raised reddened areas around the nipple pores, getting a
little piece of "tissue" in the milk.  I told her these things really
concerned me and that I felt she was pushing it too hard and to switch to an
automatic cycling pump and to limit herself to 10 - 15 minutes per side.  I
emphasized she could really hurt herself pushing things too far.  She was
getting more yellow fluid using the rougher methods but she agreed verbally
to slow down to my recommendations.

So, any suggestions, including the "what are you crazy!" variety are
welcome.   I'm in over my head here although I have been honest with the
client about this.  It is interesting I must admit.

Thanks in advance,
Carla