Devastated woman ‘wants to spare future mothers and babies’ with consequences of gender transition

Ten years after having her breasts surgically removed, Elizabeth realised the enormity of her mistake. Experts say others like her deserve to be warned.

Western Sydney University’s Karleen Gribble. Picture: Britta Campion

Moments after Elizabeth gave birth, her baby son was placed on her chest. As newborns do, his tiny body began to “breast crawl” across his mother’s chest, searching for her nipple, instinctively seeking milk.

To Elizabeth’s devastation, it was in vain. More than a decade earlier she had had chest masculinisation surgery, a procedure that was part of medical gender transition she regrets as a “terrible mistake”.

“It was really hard knowing that my son wanted to breastfeed and I couldn’t give him that … and when they put him on my stomach, he crawled up, he was looking for my breasts, and he couldn’t find them. And he tried to suck on my chin. And he spent so much time in his early life trying to find my breasts.”

Elizabeth’s story has been published in the first academic paper to document a case of a woman who had chest masculinisation surgery to affirm a gender identity as a trans man but who later detransitioned, became pregnant and grieved her inability to breastfeed.

The paper’s authors, Western Sydney University adjunct associate professor Karleen Gribble and professor of midwifery Hannah Dahlen, have raised the alarm that the increased numbers of young women undergoing gender-affirming surgery are not being warned about the future consequences.

“We know that there are a lot more children and adolescents presenting at gender clinics in Australia. We don’t know how many are going on to have surgeries like this,” Professor Gribble said. “We really don’t have any good indication of what proportion of young people might take this path and regret it at a later point.”

Elizabeth, now in her 30s, first began to experience discomfort in her female body when she began to develop breasts as a 10-year-old and was subject to unwanted attention from men and other children. At 15, she heard about the concept of gender identity and “became persuaded that her bodily discomfort was because she was transgender”.

“There were not very unusual reasons underlying why she identified as trans to start with, and why she hated her breasts,” Professor Gribble said. “It’s really not uncommon for girls to hate their breasts.”

The increased numbers of adolescent girls presenting at gender clinics with sudden-onset gender-related distress and no past history of identifying as the opposite sex is something that is concerning doctors at the Children’s Hospital at Westmead, who have questioned whether this group is “being drawn to the construct of gender dysphoria because of some evolving social process”.

Professor Gribble predicts in coming years there may be many more women who regret gender-affirming surgery, who go on to become pregnant and realise they cannot breastfeed, who were never warned by surgeons this would be the case – a situation she describes as unethical and possibly negligent. She is critical that the AusPATH standards of care for transgender medicine make no mention of the ramifications for breastfeeding at all.

Elizabeth’s chest surgery was a disaster, with her right nipple graft “chronically leaking a watery fluid, while voids in her scarred left nipple graft accumulated a smelly paste that had to be regularly squeezed out”. Surgery to reduce scars left “her chest sunken and nipple-less while scarring and nerve pain remained”.

After she detransitioned and became pregnant, her attempts to explain to midwives her distress at not being able to breastfeed were rebuffed. She was so distressed that she was referred to an obstetrician who had received training on the care of transgender people but apparently did not understand that Elizabeth had detransitioned. According to the paper, the doctor was intent on “correctly gendering this birthing parent”.

Elizabeth eventually was able to obtain donor breast milk for her baby but she wants to warn other young people considering undergoing mastectomies or taking cross-sex hormones of the long-term effects.