The study recruited 22 participants who self-identified as transmasculine and who either were or had been pregnant. MacDonald and his team interviewed these participants about their experiences, and analyzed the conversations “with a goal of describing and interpreting patterns and themes that emerged,” in the study’s words. It’s an approach that’s community-based and trans-led—and the study includes explicit declarations of actions that care providers need to take to better accommodate trans folks.

Alanna Kibbe, a registered midwife out of Toronto, Ontario, and one of the study authors, explains this approach by contending that “the wisest people in a community who can speak for it are those people living in the community and with lived experience, not the person with the most degrees or years of clinical practice.”**

Of the studies’ participants, 16 chestfed their babies. Nine of these chestfeeders reported no gender dysphoria—defined by the study as “the experience of distress or anxiety regarding one’s gender and body.” But two of the participants who initiated chestfeeding reported having to stop as a result of “overwhelming gender dysphoria.” Often this feeling was tied to the way the world perceived their body. One participant, whom the study refers to as Emmett, described his experience to the researchers thusly: “I was producing a ton of milk. … I didn’t have anything ready socially, either. I didn’t have any zip-up binders. I had no way to stop the milk from leaking through my chest. I had no appropriate … male clothes for nursing.”

The study also underscored the problems transmasculine people can run into when dealing with doctors and other care providers. Some participants who didn’t chestfeed their babies still struggled with mastitis and engorgement after birth, and reported that their providers weren’t prepared to deal with it, because the providers assumed their milk wouldn’t come in due to chest surgery.*** Other participants noted that doctors sometimes contributed to feelings of dysphoria by referring to them with female pronouns.

Based on these findings, MacDonald and his team argue in the study that there is a big need for care providers to have a better understanding of issues that affect the trans community—a conclusion that echoes the findings of one of the only other studies on this issue, “Transgender men and lactation: what nurses need to know,” published last year in The American Journal of Maternal/Child Nursing. Emily Wolfe-Roubatis, a nursing student at the University of Pennsylvania and one of this earlier study’s authors, says that a key takeaway from her research is “the very rudimentary place we’re in with being able to provide services for these folks, both in the literature and with speaking with people.”

So what can be done? Kribbe feels that one of the most important points of this research is urging care providers to be especially attentive to the terms they use. Part of that, she says, starts with the kind of education that obstetricians, midwives, and lactation counselors receive, but another part involves providers being willing to educate themselves about terminology that is gender neutral, as opposed to the gendered-female language that currently dominates lactation support. Even acknowledging that the need for change exists in the first place is an important step, the researchers contend.