With rising rates of surrogacy, induced lactation is increasingly relevant, allowing women who did not undergo pregnancy to breastfeed. In this case report, we describe the clinical management of a patient with complete androgen insensitivity syndrome (CAIS) who wished to breastfeed. We review the literature regarding lactation induction using pharmacological and non-pharmacological therapies in arranged mothers – XX women, transwomen (XY) and women with CAIS (XY). To our knowledge, there are only two case reports in the literature describing induced lactation in transwomen and CAIS respectively.
A 32-year-old married woman with CAIS was expecting a child by a surrogacy arrangement. She had been on oestrogen therapy since the diagnosis of CAIS at age 18 years. When the surrogate mother was at 32 weeks gestation our patient expressed a desire to be able to breastfeed the infant. Based on published case reports and review articles on lactation induction, in addition to her regular oestrogen therapy, our patient was commenced on a combination of two actuations of Estrogel daily (to increase circulating oestradiol), a galactagogue and regular mechanical breast stimulation eight weeks prior to the delivery of her baby. On delivery of her child, Estrogel was ceased. The patient produced a small quantity of breastmilk, allowing suckling of the infant for a short time but not sufficient for effective breast feeding.
Induced lactation is possible in chromosomally XY individuals. Based on our experience and the published literature, it is more successful in cis/trans-women who have had progesterone/progestogen exposure to the breast which is important for ductal maturation and lobular formation. We conclude that the addition of a progestogen to our patient’s treatment regimen, either as part of her hormone therapy or part of the lactation induction program would have improved her chances of establishing successful lactation.