From one-size-fits-all to client-defined feeding success: toward competency-based affirming lactation care for transgender and gender-diverse families

Background Transgender and nonbinary childbearing people often navigate lactation systems shaped by heteronormative, cisnormative “maternity” frameworks, which can limit how feeding is discussed, documented, and supported. Traditional frameworks often define “successful feeding” in biomedical, dyadic terms (e.g., milk volume, latch, growth, bonding). For transgender and nonbinary parents, goals may include these outcomes, but may also prioritize combination or formula feeding, parental wellbeing, reduced dysphoria, family connection, and affirmation of parental identity, requiring a more individualized definition of success. Aim This qualitative study examined lactation support providers’ (LSPs) experiences providing lactation care to transgender and gender-diverse (TNGD) families. Method We conducted semi-structured interviews with 11 LSPs recruited through professional networks and snowball sampling, and analyzed transcripts using thematic analysis. Results Five themes emerged: (1) Beyond feeding: the emotional and relational significance of bodyfeeding and the importance of client-defined outcomes; (2) Affirming care as individualized tailoring, grounded in humility, repair, and patient-preferred language, rather than “performing competence”; (3) Planned feeding pathways as proactive, protocol-driven, and medically coordinated care; (4) Trust, trauma, and institutional bias, including harms related to misgendering and non-inclusive systems and documentation; and (5) Uneven preparedness, with most competency acquired through self-education and community proximity rather than formal training. Conclusions Findings highlight the need for personalized, gender-affirming, language-sensitive care. This requires broadening how feeding goals are assessed beyond biomedical markers (e.g., milk supply, latch, transfer) to include outcomes that matter to many TNGD families, gender affirmation, dysphoria reduction, role embodiment, family connection, and sustaining infant nutrition through combination or formula feeding. It also calls for recognizing diverse bodily capacities to nourish, comfort, and connect with infants even when lactation follows non-normative pathways. Competency-based training, inclusive documentation, and clear clinical pathways, including for induced lactation and post-surgical care, are essential to advancing equitable lactation support for TNGD families.