Lactation suppression
Disclaimer
The purpose of this content is to provide health care professionals with key messages and evidence-informed recommendations for gender-affirming care in British Columbia (BC). This content was developed by provincial subject matter experts. The review process involved an internal evaluation by interdisciplinary healthcare professionals at Trans Care BC, as well as an external review conducted by additional interdisciplinary healthcare professionals and community members from across the province.
This content reflects the best available knowledge and resources at the time of publication. Trans Care BC documents are intended to provide information, education, and guidance only and should not be used as a substitute for clinical judgement and assessment of the individual needs of transgender, Two-Spirit, and non-binary people. Health care professionals should continue to exercise clinical judgement and take into consideration context, resources, wise practices, and other relevant factors when providing gender-affirming care.
Provincial Health Services Authority (PHSA) and Trans Care BC are not liable for any damages, claims, liabilities, costs, or obligations arising from the use of this document including loss or damages from any claims made by a third party. PHSA and Trans Care BC also assume no responsibility or liability for changes made to this document without their consent.
For clients who are pregnant and not planning to bodyfeed, suppressing lactation through pharmacological or non-pharmacological methods may be desired.
If client is not planning to bodyfeed and wants to restart or start testosterone, they can begin taking it in the immediate postpartum.
A Cochrane systematic review found that there is insufficient evidence to recommend a specific method or medication for suppressing lactation [1]. For clients who do not want to bodyfeed, review pharmacological and non-pharmacological methods of lactation suppression before birth.
Clients who have had chest contouring or reduction surgery may still experience lactogenesis II (mature milk ‘coming in’) in the first few days after giving birth. For clients who have had chest surgery who do not want to bodyfeed, review lactation suppression options.
The client handout What to Expect During & After Pregnancy includes a discussion of chest changes during and after pregnancy, as well as management of engorgement and mastitis.
The client handout Bodyfeeding After Chest Surgery includes considerations and strategies for bodyfeeding after gender-affirming chest surgery.
Clients may experience increased body dysphoria when bodyfeeding and may need to stop bodyfeeding as a result. This document focuses on lactation suppression in the immediate postpartum but non-pharmacological methods can be used at any time to suppress lactation.
Immediate pharmacological lactation suppression
Pharmacological lactation suppression prevents lactogenesis II, preventing engorgement and the associated pain. It may also decrease chest growth related to lactogenesis II. Pharmacological lactation suppression should not be used for clients who are undecided about bodyfeeding.
Cabergoline is a dopamine receptor blocker that inhibits prolactin secretion, preventing lactogenesis from occurring [2,3]. It is given as a one-time dose in the first 2-3 postpartum days but is most effective on the first day postpartum. Common adverse effects include headache, fatigue, dizziness, nausea, and orthostatic hypotension.
For more information, see Immediate Suppression of Lactation Following Birth.
Cabergoline is approved by Health Canada for the prevention of lactation in the postpartum period and is on the BC Hospital Formulary (BC Women’s Hospital + Health Centre, 2023). Due to the time sensitive nature of cabergoline, checking availability at your hospital prior to the client’s birth is recommended.
There is no known interaction between cabergoline and testosterone (UpToDate, 2023).
Non-pharmacological lactation suppression
When using non-pharmacological methods, the body will undergo lactogenesis II and the milk will ‘come in.’ By not removing milk, the body will gradually cease milk production. Strategies focus on comfort and management of engorgement.
For an in-depth review of engorgement and mastitis, see the Academy of Breastfeeding Medicine’s Clinical Protocol #36: The Mastitis Spectrum.
Detailed client resource (uses gendered language) from the Academy of Breastfeeding Medicine: Mastitis in Breastfeeding.
General recommendations
- Binding the chest lightly may be helpful, but tightly binding may lead to pain, inflammation, and mastitis.
- Expressing small amounts of milk, just to comfort.
- Cool clothes, ice packs, and cold compresses can be used for comfort and to decrease pain. Cold cabbage leaves may decrease engorgement pain more effectively than cold compresses, but the evidence is of low quality [4].
- Pain can be managed using over the counter analgesics and anti-inflammatory medications, if not contraindicated.
- If a client is suppressing lactation after establishing their milk supply, they should gradually reduce the frequency of milk expression, dropping one feeding or pumping session every 2-3 days.
Herbal remedies to support lactation suppression
Most herbs used for lactation suppression are based in traditional ways of knowing and have not undergone rigorous testing (e.g., randomized control trials). We recommend consulting a herbalist or naturopath if you want more information about herbal remedies for lactation suppression.
- Oladapo OT, Fawole B. Treatments for suppression of lactation. Cochrane Pregnancy and Childbirth Group, editor. Cochrane Database of Systematic Reviews. 2012 [cited 17 Oct 2023]. doi:10.1002/14651858.CD005937.pub3
- BC Women’s Hospital + Health Centre. Appendix 1: Literature summary for lactation suppression treatment for post-partum women. 2015. Available: http://www.bcwomens.ca/Professional-Resources-site/Documents/Oak%20Tree/Immediate%20Suppression%20of%20Lactation%20Appendix%201%20-%20Lit%20summary.pdf
- BC Women’s Hospital + Health Centre. Immediate suppression of lactation following birth procedure. 2023. Available: http://shop.healthcarebc.ca/phsa/BCWH_2/BC%20Women%27s%20Hospital%20-%20Maternal%20Newborn/C-06-11-61630.pdf
- Zakarija-Grkovic I, Stewart F. Treatments for breast engorgement during lactation. Cochrane Pregnancy and Childbirth Group, editor. Cochrane Database of Systematic Reviews. 2020;2020. doi:10.1002/14651858.CD006946.pub4
| Current version | January 14, 2025 | |
| Authors | Caitlin Botkin | Nurse Educator, Trans Care BC; Registered Midwife (non-practicing) |
| Rowan McNiven Gladman | Registered Midwife, IBCLC | |
Disclaimer
The purpose of this content is to provide health care professionals with key messages and evidence-informed recommendations for gender-affirming care in British Columbia (BC). This content was developed by provincial subject matter experts. The review process involved an internal evaluation by interdisciplinary healthcare professionals at Trans Care BC, as well as an external review conducted by additional interdisciplinary healthcare professionals and community members from across the province.
This content reflects the best available knowledge and resources at the time of publication. Trans Care BC documents are intended to provide information, education, and guidance only and should not be used as a substitute for clinical judgement and assessment of the individual needs of transgender, Two-Spirit, and non-binary people. Health care professionals should continue to exercise clinical judgement and take into consideration context, resources, wise practices, and other relevant factors when providing gender-affirming care.
Provincial Health Services Authority (PHSA) and Trans Care BC are not liable for any damages, claims, liabilities, costs, or obligations arising from the use of this document including loss or damages from any claims made by a third party. PHSA and Trans Care BC also assume no responsibility or liability for changes made to this document without their consent.