Lactation Induction in a Transgender Woman With Electrocardiogram Abnormalities

Transgender women choosing to become parents may wish to undergo lactation induction protocols so they can participate in breastfeeding. Several reports have been published describing lactation induction in transgender women using domperidone-based protocols. Although domperidone is generally well-tolerated, it carries risks for ventricular arrhythmias, and providers may be wary of using domperidone in individuals who have any abnormal findings on electrocardiogram (EKG).

Here we report successful use of a domperidone-based protocol to induce lactation in a transgender woman who showed multiple EKG abnormalities over the clinical course, including first degree atrioventricular block and right bundle branch block, as well as non-pathogenic QT elongation while on a therapeutic dose of domperidone. We also highlight institutional barriers that our patient faced when seeking out medical assistance for lactation induction.

Domperidone can be safely deployed for lactation induction in transgender women, but monitoring for potential cardiac adverse events is essential. We encourage clinicians lacking experience in lactation induction to engage with transgender patients seeking this type of care in a collaborative manner, rather than refusing outright to provide care.