Lactation suppression
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 | |
Given the rise of hate and violence against trans, Two-Spirit and non-binary people and gender-affirming care providers, some authors may have chosen to withhold their names to ensure personal and professional safety.