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[(transgender)-240.1(individuals)-238.2(reported)-241.6(having)-238.3(at)-233.9(least)-238.3(one)-240.6(negative)]TJ
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(6)Tj
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[(At)-233.6(its)-228(most)-236(se-)]TJ
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[(communities)-287.8(have)-283.2(been)-283.2(marginalized)-290.2(in)-278.8(health)-285.7(care)-284.3(systems)]TJ
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T*
[(names)-435.1(and)-430.7(pronouns,)-432.5(and)-436.4(recognizing)-436.3(individual)-433.2(patients)]TJ
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[(ship)-442.1(and)-448(put)-446.9(the)-448.1(patients)-450.1(health)-446.9(at)-447(risk.)-445.5(When)-445.6(done)]TJ
T*
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T*
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[(dividuals)-455.8(gender)-452.4(or)-451.4(sexual)-452.4(orientation)-452.7(can)-454.9(be)-452.6(minimized)]TJ
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[(with)-276.2(increased)-273.7(training)-275.3(and)-275.2(by)-267.1(having)-272.8(inclus)-7.8(ive)-269.5(systems)-274.6(and)]TJ
T*
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T*
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T*
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[(-)-496.4(avoiding)-407.7(gendered)-403.9(prexes)-401.3(and)-407.6(pronouns)-400.3(when)-403.9(some-)]TJ
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[(ones)-248.3(gender)-250.8(is)-244(unknown)-250.5(\(e.g.,)-245.1(use)-246.2(a)-249.9(patients)-248.6(given)-248.7(rst)]TJ
0 -1.1174 TD
[(and)-396.1(last)-391.5(name,)-391.5(or)-388.1(another)-396(nongendered)-395.7(culturally)-394(spe-)]TJ
0 -1.1116 TD
[(cic)-335(form)-339.6(instead)-332.6(of)-336.2(Mr./Ms.)-336.6(X\).)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 313.0582 637.3983 Tm
[(Effects)-340(of)-330.2(Transition-Related)-336.4(Health)-339.1(Care)]TJ
0 -1.2203 TD
[(on)-340.1(Pregnancy)-330.4(and)-338.2(Breast/Chestfeeding)]TJ
/F6 1 Tf
9.843 0 0 9.843 323.0361 610.0156 Tm
[(Transgender)-356.4(and)-355.8(gender)-354.5(expansive)-353.2(individuals)-353.4(may)-357(seek)]TJ
-1.0137 -1.1174 TD
[(out)-452.7(gender-afrming)-458.8(medical)-456.2(and/or)-451.4(surgical)-454.7(treatment)-452.7(to)]TJ
0 -1.1116 TD
[(help)-431.9(align)-427.4(their)-433.1(physical)-431.7(appearance)-432.7(to)-428.5(their)-433.1(gender)-429.4(iden-)]TJ
T*
[(tity.)-336.5(These)-337.1(therapies)-341.7(can)-333.9(begin)-335.1(in)-336.4(early)-336.2(adolescence)-341.6(for)-337.3(the)]TJ
0 -1.1174 TD
[(purpose)-682.5(of)-681.8(pubertal)-679.5(suppression.)-684.4(Hormone)-679.1(therapy)-678.3(for)]TJ
0 -1.1116 TD
[(transgender)-372.6(individuals)-370.7(is)-370.8(typically)-369.9(either)-372(masculinizing)-370.7(or)]TJ
T*
[(feminizing)-9.2(.)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 323.0361 529.1148 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 331.9369 527.8109 Tm
-.0161 Tc
[(Pu)-16.1(b)10.5(e)-1.1(rt)-16.1(a)9.2(l)-656.7(supp)-16.1(r)10.5(e)-1.1(ss)-16.1(i)10.6(o).1(n)-656.5(a)-1.1(nd)-656.5(ti)-16.1(m)9.1(i)-.1(ng)-656.5(of)-656.5(gen)-16.1(d)10.5(er-)-16.1(a)9.4(fr)-16.1(m)9.3(ing)]TJ
T*
-.0159 Tc
[(tr)-15.9(e)9.6(a)-.9(tmen)-15.9(t)10.6(s).5(:)-788.9(g).3(o)-15.9(n)10.7(ado)-15.9(t)10.6(rop)-15.9(i)10.6(n)-788.8(rele)-15.9(a)8.4(s).5(in)-15.9(g)-778.4(hormo)-15.9(n)10.7(e)-790(a)-.9(gon)-15.9(i)10.6(s).5(t)]TJ
0 -1.1174 TD
-.0156 Tc
[(\(G)-15.6(N)9.3(R)-.4(Ha\))-252.8(t).5(he)-15.6(r)9.9(a)-.6(py)-252.8(may)-252.8(be)-254(used)-252.8(in)-252.8(care)-15.6(f)9.9(ull)-15.6(y)-236.8(s)-15.6(e)10(lect)-15.6(e)9.7(d)-247.1(ea)-15.6(r)9.9(l).5(y)]TJ
0 -1.1116 TD
[(ad)-15.7(o)10.9(l).4(es)-15.7(c)9.9(e)-.7(nts)-373.7(t)-15.7(o)-357.8(t)-15.7(e)9.6(m)-.7(por)-15.7(a)9.8(r).5(il)-15.7(y)-363.6(h).5(alt)-374(t).4(h)-15.7(e)-358.9(d)-15.7(e)9.7(velo)-15.7(p)10.9(ment)-374(o).5(f)-373.9(s)-15.7(e)9.9(c)-.7(-)]TJ
T*
-.0159 Tc
[(on)-15.9(d)10.7(a)-.9(ry)-351.1(s)-15.9(e)9.7(xua)-15.9(l)-341.9(c)-.9(har)-15.9(a)9.6(cter)-15.9(i)10.6(s).5(ti)-15.9(c)9.4(s)-350.9(to)-356.8(less)-15.9(e)9.7(n)-351.1(gen)-15.9(d)10.7(er)-351(dy)-15.9(s)10.9(pho)-15.9(r)10.7(i).1(a)]TJ
0 -1.1174 TD
-.0157 Tc
[(an)-15.7(d)-519(a)-.7(l)-15.7(l)10.6(ow)-536(time)-536.3(for)-535.1(dec)-15.7(i)9.6(sio)-15.7(n)10.9(s)-529.2(t)-15.7(o)-519.1(b)-15.7(e)-520.2(mad)-15.7(e)-520.2(c)-.7(o)-15.7(n)10.9(cern)-15.7(i)10.8(ng)]TJ
0 -1.1116 TD
[(ge)-15.7(n)9.7(d).5(er-)-15.7(a)9.8(fr)-15.7(m)9.7(ing)-356.6(t)-15.7(r)10.8(eatme)-15.7(n)9.7(t).4(s.)-359(The)-357.8(u)-15.7(s)11.1(e)-357.8(of)-356.6(GN)-15.7(R)9(H)-.4(a)-357.8(p).5(au)-15.7(s)11.1(e)-.7(s)]TJ
T*
[(th)-15.7(e)-272.5(d).5(ev)-15.7(e)9.7(l).4(opm)-15.7(e)8.5(n).5(t)-281.9(o)-15.7(f)-271.3(i).4(r)-15.7(r)11(ever)-15.7(s)11.1(i).3(bl)-15.7(e)-272.6(s).7(e)-15.7(c)8.6(onda)-15.7(r)9.8(y)-281.7(s)-15.7(e)9.9(xual)-287.6(c)-.7(har)-15.7(a)9.8(c-)]TJ
0 -1.1174 TD
0 Tc
[(t)16(e)0(r)25.5(i)16.1(s)16.4(t)0(i)26.3(c)15(s)16.4(,)-274.1(bu)26.6(t)-271.9(a)0(l)25.3(s)16.4(o)-277.6(p)16.2(r)16.2(e)15(ve)25.4(n)16.2(t)16.1(s)-277.4(m)15(a)15(t)16.1(ur)26.6(a)15(t)16.1(i)16.1(o)0(n)-261.4(o)16.2(f)-277.5(p)16.2(ri)26.5(m)15(a)15(r)16.2(y)-277.6(o)16.2(o)16.2(c)15(yt)26.5(e)15(s)]TJ
0 -1.1116 TD
-.0157 Tc
[(an)-15.7(d)-444.1(s)-15.7(p)11.1(e)-.7(rm)-15.7(a)8.5(t).4(ogo)-15.7(n)10.9(i).4(a.)]TJ
7.3823 0 0 6.5614 408.8125 433.5306 Tm
-.0162 Tc
(19)Tj
9.843 0 0 9.843 420.4345 429.1653 Tm
-.0159 Tc
[(Fo)-15.9(r)-450(a)-.9(dole)-15.9(s)9.7(cen)-15.9(t)10.6(s)-460.3(who)-460.5(m)-.9(ov)-15.9(e)-451.2(from)]TJ
-8.9909 -1.1116 TD
[(GN)-16(R)8.7(H)-.7(a)-260.2(t)-16(h)10.5(e)-1(ra)-16(p)9.4(y)-259(o)-16(n)-248.6(to)-264.8(cro)-16(s)10.8(s-g)-16(e)9.4(nde)-16(r)-249.7(h).2(o)-16(r)10.6(mone)-16(s)9.6(,)-261.3(no)-264.8(curr)-16(e)9.5(n).2(t)]TJ
T*
0 Tc
[(s)16.4(t)0(u)26.5(d)16.2(i)16.1(e)0(s)-250.8(a)0(d)25.4(d)16.2(r)16.2(e)0(s)25.6(s)-265.8(t)16(h)16.2(e)-267.2(p)16.2(os)26.8(s)16.4(i)16.1(bi)26.5(l)16.1(i)16(ty)-250(of)-255.6(f)16.2(u)16.2(t)16.1(ur)26.6(e)-267.2(f)16.2(e)15(r)16.2(ti)26.3(l)16.1(i)16.1(t)0(y)26.5(.)]TJ
0 -1.1174 TD
[(For)-567.6(transgender)-568.4(people)-562(who)-568.6(want)-565.3(to)-561(preserve)-570.7(their)]TJ
0 -1.1116 TD
[(fertility)-345.7(and/or)-341.9(breast/chestfeeding)-350.5(capability,)-341(deciding)]TJ
T*
[(when)-398.1(to)-394(start)-398.4(gender-afrming)-395.5(treatment)-400.9(can)-397.3(be)-395(dif-)]TJ
0 -1.1174 TD
[(cult.)-452.8(For)-446.6(exam)-8(ple,)-445.8(delaying)-454.9(gender-afrming)-453.1(female-)]TJ
0 -1.1116 TD
[(to-male)-253.4(chest)-255.4(reconstruction)-255.2(\()49.7(top)46.3()-248.7(surgery\))-251.6(for)-250.9(a)-255.7(trans)]TJ
T*
[(man)-437.7(until)-437.9(after)-439.9(the)-442.3(completion)-441.2(of)-434.1(breast/chestfeeding)]TJ
0 -1.1174 TD
[(may)-287.9(prolong)-290(his)-285.5(distressing)-289.5(gender)-291.1(dysphoria)-293.2(for)-285.5(many)]TJ
0 -1.1116 TD
(years.)Tj
7.3823 0 0 6.5614 355.2377 323.9432 Tm
(3)Tj
9.843 0 0 9.843 364.422 319.5779 Tm
[(In)-560.9(addition)-563.3(to)-561(the)-557.5(risk)-563(of)-560.9(continued)-559.7(gender)]TJ
-3.3003 -1.1116 TD
[(dysphoria,)-337(another)-332.7(challenge)-343.1(is)-330.4(the)-332.9(lack)-340.9(of)-330.5(data)-335.2(on)-336.3(the)]TJ
T*
[(effects)-517.9(of)-509(postpubertal)-511.1(hormone)-516.9(therapy)-511.2(on)-509(fertility,)]TJ
0 -1.1174 TD
[(including)-656.6(the)-655.4(thresholds)-657.1(for)-654.1(causing)-655.1(infertility.)]TJ
7.3823 0 0 6.5614 535.5211 291.0613 Tm
[(19,)-9.4(20)]TJ
9.843 0 0 9.843 331.9369 275.7543 Tm
[(Fertility)-656.6(preservation)-661.8(is)-653(a)-658.9(growing)-653.8(eld,)-659.8(and)-655.3(new)]TJ
0 -1.1116 TD
[(methods)-557.2(are)-558.5(being)-554(investigated.)]TJ
7.3823 0 0 6.5614 466.0723 269.1779 Tm
(19)Tj
9.843 0 0 9.843 478.9416 264.8125 Tm
[(Various)-556.8(forms)-553.6(of)]TJ
-14.9349 -1.1174 TD
[(fertility)-547.3(preservation)-552.4(exist)-548.1(\(i.e.,)-544.7(testicular)-550.4(sperm)-543.3(ex-)]TJ
0 -1.1116 TD
[(traction)-437.7(and)-430.7(banking,)-432.9(oocyte)-435.3(harvesting)-433.8(and)-436.4(banking,)]TJ
T*
[(and)-563.2(ovarian)-563.1(tissue)-566.3(cryoprecipitation\))-572.2(and)-563.2(should)-559.5(be)]TJ
0 -1.1174 TD
[(discussed)-271(with)-264.7(individuals)-267(before)-268.1(starting)-269.3(therapies)-272.6(that)]TJ
0 -1.1116 TD
[(may)-334(affect)-338.5(fertility.)]TJ
7.3823 0 0 6.5614 410.2865 214.3559 Tm
[(19,21)-7.8(,22)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 323.0361 200.3527 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 331.9369 199.0488 Tm
[(Feminizing)-308.5(treatments)-309.6(and)-304(practices:)-309.6(Hormone)-304.7(therapy)]TJ
0 -1.1174 TD
[(for)-527.4(trans)-524.9(women)-527.2(and)-522.8(transfeminine)-531.8(people)-527.4(typically)]TJ
0 -1.1116 TD
[(includes)-454.7(an)-452.6(estrogen)-454.5(and)-453.7(antiandrogen)-460.4(\(such)-449.9(as)-458.2(spir-)]TJ
T*
[(onolactone\),)-238.1(and)-240.6(may)-236.1(also)-235.9(include)-234.9(a)-238.4(progestin.)-233.4(Estrogen)]TJ
T*
[(therapy)-476.7(will)-478(induce)-481.4(breast)-475.4(tissue)-479.9(development.)]TJ
7.3823 0 0 6.5614 526.2802 159.5905 Tm
[(21,2)-8.6(3,24)]TJ
9.843 0 0 9.843 331.9369 144.2267 Tm
[(There)-441(is)-434.1(one)-436.4(case)-433.9(report)-439.8(and)-436.4(many)-433(anecdotal)-441.1(reports)]TJ
T*
[(of)-365(tr)15(an)19.7(s)-375.3(w)0(o)20(m)0(e)18.4(n)-375.5(in)20.7(du)20.8(ci)19.6(ng)-365.1(la)13.8(ct)19.5(at)19.5(io)20.7(n)-375.5(\()0(s)21.1(e)0(e)-367.4(I)0(n)15.1(d)0(u)20.8(c)0(e)18.5(d)-375.5(La)18.5(ct)19.5(a-)]TJ
T*
[(ti)20.6(on)-221.1(an)19.7(d)-231.5(C)0(o)19.8(l)0(a)13.8(c)0(t)19.5(a)0(t)19.5(i)0(o)20.7(n)-231.5(se)19.9(ct)19.6(io)15(n\))-221(an)19.7(d)-231.5(p)0(r)20.9(o)0(d)20.8(u)0(c)19.7(i)0(n)20.7(g)-231.5(hu)15.1(m)15(a)0(n)-222.2(m)0(i)19.5(l)0(k)15(.)]TJ
0 -1.1174 TD
[(Br)19.8(ea)18.5(st)-370.8(au)13.9(gm)19.6(en)19.7(ta)19.6(ti)20.6(on)-370.8(in)-370.9(tr)20.7(an)19.7(s)-381(w)0(o)20(m)0(e)18.4(n)-381.2(ma)18.4(y)-381.2(m)0(a)18.5(s)0(k)-370.6(i)0(n)20.7(a)0(d)19.7(e)0(-)]TJ
0 -1.1116 TD
[(qu)20.8(at)19.5(e)-273(m)15(am)18.5(ma)18.4(ry)-261.4(ti)20.6(ss)21.2(ue)-256.8(de)13.9(ve)19.7(lo)20.7(pm)19.6(en)19.7(t)-266.2(o)0(r)-255.6(r)0(e)14(s)0(u)21(l)0(t)-255.9(i)0(n)-255.8(p)0(r)15.1(e)0(s)19.9(s)0(u)21(r)0(e)]TJ
T*
[(at)19.5(ro)15.1(ph)20.8(y)-254.5(o)0(f)-244.1(r)0(e)19.7(m)0(a)18.4(i)0(n)20.7(i)0(n)20.7(g)-254.5(ti)20.6(ss)15.5(ue)19.7(.)-251.1(I)0(t)-244.2(m)0(a)18.4(y)-254.5(al)19.5(so)-243.9(in)20.7(cr)13.9(ea)18.5(se)-245.1(th)20.7(e)-255.7(r)0(i)20.7(s)0(k)]TJ
0 -1.1174 TD
[(of)-313.2(en)19.7(go)15.1(rg)20.9(em)18.4(en)19.7(t)-323.8(d)0(u)20.8(r)0(i)20.7(n)0(g)-313.2(i)0(n)14.9(d)0(u)20.8(c)0(e)18.5(d)-323.6(la)19.6(ct)19.5(at)19.5(io)20.7(n.)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 323.0361 68.8252 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 331.9369 67.5212 Tm
[(Masculinizing)-508.6(treatments)-511.2(and)-505.6(practices:)-511.2(Testosterone)]TJ
0 -1.1116 TD
[(therapy)-378.8(for)-377.6(transgender)-384.1(men)-374.3(or)-376.5(transmasculine)-384.1(people)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 62.022 749.6502 Tm
(286)Tj
46.3849 0 TD
[(ABM)-336(PROTOCOL)]TJ
ET
endstream
endobj
51 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
9.843 0 0 9.843 78.633 725.1588 Tm
0 0 0 rg
0 Tc
0 Tw
[(suppresses)-266(endogenous)-260.8(estrogen)-264.5(production)-260.1(that)-265(can)-259.1(re-)]TJ
0 -1.1174 TD
[(sult)-361.6(in)-365.2(atrophy)-366.1(of)-359.3(estrogen-responsive)-370.8(breast)-365.9(tissues.)]TJ
7.3823 0 0 6.5614 291.4582 718.5825 Tm
(25)Tj
9.843 0 0 9.843 78.633 703.2188 Tm
[(Trans)-359(men)-351.3(who)-355.5(are)-356.9(gestational)-361.5(parents)-355.5(generally)-359.2(must)]TJ
0 -1.1116 TD
[(suspend)-509.6(testosterone)-512(therapy)-505.5(during)-507.8(pregnancy.)-512.1(This)]TJ
T*
[(suspension)-328.5(may)-322.5(be)-325.9(continued)-329.3(in)-324.9(the)-321.4(postpartum)-330.2(period)]TJ
0 -1.1174 TD
[(if)-589.8(lactation)-589.9(is)-589.6(desired.)-589.3(In)-583.9(addition,)-589.8(trans)-588.3(men)-593.2(may)]TJ
0 -1.1116 TD
[(practice)-382.3(chest)-382.1(binding)-376.6(\(using)-380.9(a)-376.6(tight)-380.3(compressive)-385.2(gar-)]TJ
T*
[(ment)-271.9(or)-272.9(bandage)-270.4(to)-273(atten)-274(the)-269.5(appearance)-277.2(of)-272.9(the)-269.5(chest\))-8.8(.)]TJ
0 -1.1174 TD
[(This)-472.1(may)-478(result)-474.3(in)-474.6(compression)-476.2(atrophy,)-473.2(worsen)-475(en-)]TJ
0 -1.1116 TD
[(gorgement,)-460.5(or)-451.4(lower)-462.7(milk)-455.1(supply.)-453.5(Finally,)-456(trans)-461.6(men)]TJ
T*
[(who)-430.4(have)-432.9(undergone)-432.7()50.8(top)46.3()-427.3(surgery)-434.8(may)-431.9(or)-428.4(may)-431.9(not)]TJ
0 -1.1174 TD
[(have)-605.7(the)-597.8(ability)-602.6(to)-601.3(lactate.)-609.4(Surgical)-604.5(techniques)-602.1(for)]TJ
0 -1.1116 TD
[()50.8(top)46.3()-363.9(surgery)-365.7(vary)-362.6(widely)-366(from)-368.4(a)-365.1(bilateral)-365.2(total)-369.9(mas-)]TJ
T*
[(tectomy)-420.5(with)-414.5(resection)-416.6(of)-416.9(the)-419.3(nipple)-417(areolar)-414.4(complex)]TJ
T*
[(\(NAC\))-509.3(to)-503.4(utilization)-510.6(of)-503.3(reduction)-507.8(pattern)-511.4(techniques)]TJ
0 -1.1174 TD
[(with)-420.2(preservation)-419.9(of)-416.9(the)-419.3(NAC)-415(on)-416.9(an)-418.1(intact)-418.3(neurovas-)]TJ
0 -1.1116 TD
[(cular)-238.3(pedicle.)-239.5(These)-239.2(techniques)-245(can)-236(result)-238.2(in)-238.5(differences)]TJ
T*
[(in)-399.7(residual)-402.8(mammary)-405.4(parenchyma)-402.8(among)-399.6(individuals.)]TJ
0 -1.1174 TD
[(Furthermore,)-387.6(if)-376.7(the)-384.7(nipple)-382.4(is)-382.3(completely)-384.7(removed)-379.9(and)]TJ
0 -1.1116 TD
[(reattached,)-389.1(the)-379(ductal)-383.6(anatomy)-380(is)-382.3(less)-379.7(likely)-382.5(to)-382.5(regen-)]TJ
T*
[(erate)-354.7(and)-350(allow)-353.4(for)-354.6(lactation,)-351.4(as)-354.5(opposed)-354.3(to)-347.9(when)-357.8(it)-348(is)]TJ
0 -1.1174 TD
(preserved.)Tj
7.3823 0 0 6.5614 119.4519 499.4077 Tm
(26)Tj
9.843 0 0 9.843 131.981 494.9857 Tm
[(Modern)-527(NAC)-524.5(tattooing)-524.2(techniques)-527.2(may)]TJ
-5.4199 -1.1116 TD
[(give)-247.6(the)-246.5(appearance)-248.4(of)-244.1(a)-249.9(native)-245.3(NAC,)-245.7(but)-245.3(the)-246.5(results)-244.9(are)]TJ
T*
[(cosmetic)-336.1(only.)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 69.7323 463.4078 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 78.633 462.1038 Tm
[(Gender)-499.4(dyspho)-6.4(ria)-499.9(as)-498.5(a)-497.6(result)-503.1(of)-497.5(lactation)-503.5(care:)-498.7(Any)]TJ
T*
[(treatment)-400.9(that)-397.5(alters)-400.6(the)-402(hormonal)-397.2(milieu)-401(of)-393.8(trans)-398.2(pa-)]TJ
T*
[(tients)-244.1(may)-247.6(increase)-249.5(their)-243(gender)-245.1(dysphoria.)-244.8(This)-247.4(may)-241.8(be)]TJ
T*
[(added)-359.2(to)-353.7(any)-361.6(suffering)-356.5(they)-357(experienced)-363.6(as)-360.3(a)-353.6(result)-359.1(of)]TJ
0 -1.1174 TD
[(fertility)-293.9(and)-286.7(pregnancy)-295.6(care.)-293.5(For)-285.3(instance,)-292.3(when)-294.4(a)-290.2(trans)]TJ
0 -1.1116 TD
[(man)-541.3(gestates,)-545.5(he)-544.8(will)-541.3(have)-542.4(hormonal)-547(changes)-546.7(from)]TJ
T*
[(suspending)-559.1(testosterone)-558.1(therapy)-557.3(and)-557.4(from)-558.5(the)-557.5(preg-)]TJ
0 -1.1174 TD
[(nancy)-336.1(itself,)-333.9(which)-336(may)-328.2(be)-337.4(stressful,)-336.7(and)-332.8(he)-331.7(may)-334(have)]TJ
0 -1.1116 TD
[(negative)-386.9(emotions)-379.9(related)-385.8(to)-382.5(his)-377.6(chest)-387.9(changes.)-383.1(Being)]TJ
T*
[(sensitive)-559.4(to)-549.5(the)-557.5(experiences)-559.3(of)-555.1(patients)-552.7(means)-556(sup-)]TJ
0 -1.1174 TD
[(porting)-681.8(them)-680.8(in)-682(their)-680.8(decision)-685.1(to)-676.2(resume)-683.8(gender-)]TJ
0 -1.1116 TD
[(afrming)-569.8(hormonal)-570(treatments)-568.8(after)-572.3(birth,)-562.1(including)]TJ
T*
[(decisions)-334.7(not)-337.5(to)-330.6(lactate.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 59.7543 308.6361 Tm
[(Fertility)-339.8(Options)]TJ
/F6 1 Tf
9.843 0 0 9.843 69.7323 292.1952 Tm
[(Reproductive)-398.1(options)-393.7(for)-389.1(LGBTQ)]TJ
/F7 1 Tf
14.0306 0 TD
(+)Tj
/F6 1 Tf
.9446 0 TD
[(individuals)-393.7(vary)-391.4(de-)]TJ
-15.9889 -1.1116 TD
[(pending)-400.7(on)-399.6(the)-396.3(personal)-396.9(preferences)-403.5(of)-399.6(the)-396.3(individuals)-399.5(in-)]TJ
0 -1.1174 TD
[(volved,)-466.4(their)-467.7(and)-471(their)-467.7(partners)-467.1(gonads)-468.4(and)-465.2(reproductive)]TJ
0 -1.1116 TD
[(organs,)-460.2(past)-460.5(or)-457.2(current)-459.4(therapies)-462.7(that)-455.1(may)-460.7(affect)-459.4(fertility,)]TJ
T*
[(access)-293.1(to)-284.6(reproductive)-287.6(endocrinology)-287.6(and)-286.7(infertility)-284.7(special-)]TJ
0 -1.1174 TD
[(ists,)-382.1(nances/insurance)-388.3(coverage,)-379.7(and)-378.8(local)-382.5(legislation.)]TJ
7.3823 0 0 6.5614 282.2172 241.7385 Tm
[(27,2)-8.6(8)]TJ
9.843 0 0 9.843 59.7543 226.4315 Tm
[(Fertility)-224.6(and)-223.3(child-bearing)-225.5(goals)-219.7(vary)-218.6(greatly)-223.4(from)-224.4(individual)]TJ
0 -1.1116 TD
[(to)-198.2(individual,)-200.4(so)-192.1(assumptions)-198.5(must)-201.4(be)-193.4(avoided.)]TJ
7.3823 0 0 6.5614 241.2283 219.8551 Tm
(2931)Tj
9.843 0 0 9.843 261.6377 215.4897 Tm
(Although)Tj
-20.5103 -1.1174 TD
[(these)-341.8(can)-333.9(be)-337.4(sensitive)-334.8(topics)-336.1(and)-338.5(providers)-333.5(may)-334(be)-337.4(uncom-)]TJ
0 -1.1116 TD
[(fortable)-247.5(with)-247.4(their)-243(own)-246.1(knowledge,)-247.1(it)-244.4(is)-244(important)-248.8(to)-244.2(provide)]TJ
T*
[(information)-291.3(on)-278.7(the)-286.8(possibilities)-286.4(and)-286.7(be)-285.6(informed)-287.7(about)-283.3(local)]TJ
0 -1.1174 TD
[(resources)-335.5(and)-332.8(legal)-330.6(restrictions.)-335.8(Patients)-328(may)-334(be)-325.9(hesitant)-333.9(to)]TJ
0 -1.1116 TD
[(bring)-230.2(up)-232.6(their)-231.5(goals)-225.5(or)-232.6(questions)-229.8(out)-228.1(of)-232.6(fear)-231.3(of)-226.8(discrimination)]TJ
T*
[(or)-370.8(violence.)]TJ
7.3823 0 0 6.5614 107.6031 154.0913 Tm
(6,29)Tj
9.843 0 0 9.843 124.1574 149.726 Tm
[(As)-371.5(a)-370.9(result,)-368.3(parents)-372.8(and)-373.1(infants)-366(may)-374.3(suffer)]TJ
-6.543 -1.1116 TD
[(poor)-280.8(outcomes)-283(during)-283.2(this)-280.9(vulnerable)-285.4(time.)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 69.7323 123.5905 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 78.633 122.3433 Tm
[(If)-549.3(ne)19.7(i)16.1(t)0(h)20.7(e)0(r)-550.5(p)0(a)19.7(r)16.2(tn)20.7(er)-550.5(ha)25.4(s)-565.4(c)0(h)25.4(i)0(l)20.6(d)0(-)26.6(b)0(e)19.7(a)0(r)25.5(i)0(n)20.7(g)-559.8(po)20.8(te)25.3(nt)20.7(i)16.1(a)0(l)-556.4(o)16.2(r)-565.5(n)0(e)25.4(i)0(-)]TJ
0 -1.1174 TD
[(th)20.7(e)15(r)-392.7(pa)19.7(rt)26.5(ne)19.7(r)-392.7(d)0(e)25.4(s)0(i)20.9(r)0(e)25.5(s)-392.6(to)-382.5(ca)18.5(r)16.2(r)0(y)-382.3(a)-393.9(pr)20.9(e)15(g)0(n)20.8(a)0(n)25.4(c)0(y)19.7(,)-389.3(th)20.7(ei)25.3(r)-392.7(o)0(p)20.8(t)0(i)26.3(o)0(n)20.8(s)]TJ
0 -1.1116 TD
[(in)20.7(c)15(l)0(u)20.7(d)16.2(e)-238.4(s)0(u)26.8(r)0(r)20.9(o)0(g)20.8(a)15(cy)-222.2(\(f)20.9(or)20.9(m)15(a)0(l)-222.4(o)0(r)-221(i)0(n)20.7(f)0(o)20.9(r)16.2(ma)18.4(l)16.1(,)-233.8(wi)19.8(th)-221.2(sp)21(e)15(r)0(m)-222.3(o)0(r)-226.8(e)15(gg)]TJ
T*
[(fr)20.9(o)16.2(m)-232.7(on)20.8(e)-232.6(o)0(r)-221(b)0(o)26.6(t)0(h)-221.2(p)0(a)19.7(r)0(t)26.5(n)0(e)19.7(r)0(s)-220.8(o)0(r)-221(f)0(r)26.7(o)0(m)-222.3(a)-232.6(do)20.8(no)26.6(r\))-221(or)-221(ad)19.7(o)16.2(p)0(t)20.7(i)0(o)26.5(n)0(.)]TJ
7.3823 0 0 6.5614 291.5716 93.8268 Tm
(32)Tj
/F8 1 Tf
7.9702 0 0 7.9702 69.7323 79.7669 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 78.633 78.463 Tm
[(If)-353.5(at)-354.8(least)-353.5(one)-355.8(partner)-355.7(has)-355.6(child-bearing)-358(potential)-352.6(\(i.e.,)]TJ
T*
[(has)-563(a)-560.9(uterus)-560.6(and)-563.2(appropriate)-568.7(hormonal)-558.5(milieu\))-563.4(and)]TJ
T*
[(desires)-338(to)-330.6(carry)-336.1(a)-336.3(pregnancy,)-339.4(they)-334(may:)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 330.7464 727.1998 Tm
(B)Tj
/F6 1 Tf
9.843 0 0 9.843 343.2755 727.1998 Tm
[(conceive)-727.8(through)-716.3(penetrative)-725.6(\(penis)-721.9(in)-722.3(vagina\))]TJ
T*
[(intercourse,)-548.9(intrauterine)-541.3(insemination,)-544.7(or)-543.6(in)-538(vitro)]TJ
T*
(fertilization;)Tj
/F9 1 Tf
6.9738 0 0 6.9738 330.7464 694.3179 Tm
(B)Tj
/F6 1 Tf
9.843 0 0 9.843 343.2755 694.3179 Tm
[(use)-338.3(sperm)-336(donation)-332.8(\(formal)-338.4(or)-330.5(informal\);)-342(or)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 330.7464 683.3762 Tm
(B)Tj
/F6 1 Tf
9.843 0 0 9.843 343.2755 683.3762 Tm
[(use)-338.3(egg)-332.8(donation)-338.5(from)-333.9(a)-330.6(partner)-338.4(or)-336.2(donated)-332.7(egg.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 310.8472 659.3384 Tm
[(Induced)-332.1(Lactation)-335.1(and)-338.2(Colactation)]TJ
/F6 1 Tf
9.843 0 0 9.843 320.8251 642.8975 Tm
[(Some)-415.6(LGBTQ)]TJ
/F7 1 Tf
6.0304 0 TD
(+)Tj
/F6 1 Tf
.9676 0 TD
[(parents)-418.9(may)-414.6(desire)-423.5(to)-411.3(induce)-423.8(lactation,)]TJ
-8.0117 -1.1174 TD
[(which)-330.2(is)-330.4(to)-324.9(start)-335(the)-327.1(production)-335(of)-324.7(milk)-334.2(in)-324.9(the)-332.9(absence)-334.7(of)-324.7(a)]TJ
0 -1.1116 TD
[(pregnancy.)-350.9(There)-354.6(are)-351.2(many)-352.4(anecdotal)-354.7(reports)-354.3(and)-350(one)-350.1(case)]TJ
T*
[(report)-336.1(of)-330.5(a)-336.3(trans)-334.9(woman)-331.3(\(AMAB,)-340.9(on)-330.5(hormone)-338.4(replacement)]TJ
0 -1.1174 TD
[(therapy\))-558.4(successfully)-557.8(inducing)-557.4(lactation.)]TJ
7.3823 0 0 6.5614 479.5085 603.4392 Tm
(33)Tj
9.843 0 0 9.843 492.3778 599.0172 Tm
[(Regarding)-560.5(in-)]TJ
-18.4426 -1.1116 TD
[(duced)-497.4(lactation)-503.5(in)-491.9(LGBTQ)]TJ
/F7 1 Tf
11.4676 0 TD
(+)Tj
/F6 1 Tf
1.0483 0 TD
[(parents,)-502.9(we)-499.6(recommend)-499.7(the)]TJ
-12.5158 -1.1116 TD
[(following)-253.1(based)-249.5(on)-249.9(our)-250.9(experience)-253.1(and)-252.1(the)-252.3(limited)-252.5(published)]TJ
0 -1.1174 TD
(information:)Tj
/F8 1 Tf
7.9702 0 0 7.9702 320.8251 550.9983 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 329.6692 549.751 Tm
[(Do)-440.8(not)-441.2(assume)-441.8(that)-443.6(a)-440(person)-439.5(with)-443.3(breasts)-441.7(will)-443.4(know)]TJ
T*
[(that)-374.4(inducing)-367.3(lactation)-376.8(is)-370.8(an)-366.2(option,)-373.2(nor)-366.1(that)-374.4(they)-368.6(will)]TJ
0 -1.1116 TD
[(desire)-348.7(to)-347.9(induce)-348.9(lactation.)-345.7(Rather,)-353.3(provide)-343(information)]TJ
T*
[(on)-693.4(its)-688.8(possibilities)-695.3(and)-695.6(ask)-689.7(open-ended)-694.1(questions,)]TJ
0 -1.1174 TD
[(such)-391.3(as,)-386.7()50.8(What)-383.4(are)-391.5(your)-384.5(thoughts)-383.3(about)-386.9(feeding)-390.3(your)]TJ
0 -1.1116 TD
[(child)43.8()-289(and)-286.7()45(What)-291.3(have)-289(you)-291.3(considered)-290.9(about)-294.8(inducing)]TJ
T*
[(lactation?)40.3()]TJ
/F8 1 Tf
7.9702 0 0 7.9702 320.8251 474.2928 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 329.6692 472.9889 Tm
[(Counsel)-263.3(the)-258(family)-256.9(about)-260.2(stress)-260.7(and)-257.9(maintaining)-263.9(mental)]TJ
T*
[(health)-498.8(and)-494(relationships.)]TJ
7.3823 0 0 6.5614 430.8093 466.4125 Tm
(34)Tj
9.843 0 0 9.843 443.055 462.0471 Tm
[(Inducing)-493.9(lactation)-503.5(can)-495.2(be)]TJ
-11.5194 -1.1116 TD
[(difcult)-315.4(and)-315.5(takes)-313(time)-318.1(and)-309.7(effort,)-316.5(which)-312.9(may)-316.7(increase)]TJ
0 -1.1174 TD
[(a)-393.9(familys)-397.1(stress)-393.2(level.)]TJ
7.3823 0 0 6.5614 422.1353 444.529 Tm
(35)Tj
9.843 0 0 9.843 433.3605 440.107 Tm
[(In)-393.8(addition,)-393.9(there)-393.8(is)-388(no)-393.9(pub-)]TJ
-10.5345 -1.1116 TD
[(lished)-434.1(research)-439.4(on)-428.4(the)-436.6(frequency)-433.8(of)-428.4(success.)-440.3(Parental)]TJ
T*
[(stress)-427.7(has)-419(neurodevelopmental)-430.4(consequences)-427.6(for)-417.9(their)]TJ
T*
[(children,)-619.6(and)-615(any)-615(benet)-613.7(of)-612.7(human)-612.7(milk)-616.4(must)-616.1(be)]TJ
0 -1.1174 TD
[(weighed)-339.3(against)-338.4(this)-332.8(risk.)]TJ
7.3823 0 0 6.5614 432.4534 400.6487 Tm
(36)Tj
/F8 1 Tf
7.9702 0 0 7.9702 320.8251 386.6455 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 329.6692 385.3416 Tm
[(There)-256.7(exists)-249.5(no)-249.9(standard)-252.9(guidance)-254.3(on)-249.9(inducing)-252.1(lactation)]TJ
0 -1.1116 TD
[(for)-590.7(any)-580.4(patient)-592.2(population.)-586.2(Different)-589.2(methods)-586(have)]TJ
0 -1.1174 TD
[(been)-427.2(used)-431.6(for)-423.7(inducing)-424.9(lactation,)-432(including)-426.2(visualiza-)]TJ
0 -1.1116 TD
[(tion/medit)-8.3(ation,)-396.3(expression)-398.9(by)-393.9(hand)-397.2(or)-393.8(pump,)-400.7(feeding)]TJ
T*
[(at)-481.5(the)-476.9(breast/chest,)-482.1(and)-476.8(combinations)-477.8(of)-480.2(oral)-472.2(contra-)]TJ
0 -1.1174 TD
[(ceptive)-264.9(use)-257.7(followed)-258.7(by)-255.6(hormone)-257.7(withdrawal)-263.1(combined)]TJ
0 -1.1116 TD
[(with)-310.8(galactogogues)-312.8(and)-309.7(expression)-306.8(\(see)-311.8(ABM)-311.4(Protocol)]TJ
T*
[(#9)-439.9()50.8(Use)-438.2(of)-434.1(Galactogogues)-440.4(in)-440.1(Initiating)-439(or)-434.1(Augment-)]TJ
T*
[(ing)-873.1(Maternal)-877.4(Milk)-875.3(Production,)-873.9(Second)-878.5(Revision)]TJ
0 -1.1174 TD
(2018)Tj
7.3823 0 0 6.5614 349.3983 291.0613 Tm
(37)Tj
9.843 0 0 9.843 356.7684 286.696 Tm
(\).)Tj
7.3823 0 0 6.5614 362.4944 291.0613 Tm
[(33,)-9.4(35,38)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 320.8251 277.0582 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 329.6692 275.7543 Tm
[(Inducing)-298.1(lactation)-296.1(may)-299.4(present)-297.9(more)-294.8(of)-295.9(a)-290.2(challenge)-302.8(for)]TJ
0 -1.1116 TD
[(transgender)-453.2(individuals.)-443.3(In)-445.7(these)-445.5(cases,)-444(one)-448(can)-443.4(gen-)]TJ
0 -1.1174 TD
[(erally)-349(refer)-347.6(to)-347.9(three)-347.7(components:)-349.8(hormonal)-345.4(priming)-349(of)]TJ
0 -1.1116 TD
[(the)-258(mammary)-261.4(tissue,)-253(prolactin)-260.3(promotion,)-256.7(and)-257.9(hormone)]TJ
T*
[(withdrawal)-343.8(with)-333.8(expression.)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 330.7464 220.9322 Tm
(B)Tj
/F6 1 Tf
9.843 0 0 9.843 343.2755 220.9322 Tm
[(Priming:)-309.7(Hormonal)-305.9(priming)-302.9(of)-307.4(the)-304.1(mammary)-307.4(tissue)]TJ
T*
[(in)-365.2(nongestating)-361.3(people)-366.2(AFAB)-364.1(generally)-365(involves)-361.4(a)]TJ
T*
[(combined)-692.2(oral)-685.3(contraceptive)-694.4(with)-685.2(estrogen)-690.7(and)]TJ
0 -1.1174 TD
[(proges)-7.5(terone)-504.4(\(e.g.,)-504.3(ethinyl)-510.4(estradiol)-507.7(and)-505.6(norgesti-)]TJ
0 -1.1116 TD
[(mate\),)-582.8(taken)-583.9(continuously)-579(for)-579.2(months)-578(without)-579.2(a)]TJ
T*
[(menstruation)-310.7(phase)-312.9(\(placebo)-311.9(pills\).)-303.9(Patients)-310.7(AMAB)]TJ
T*
[(who)-499.5(have)-502.1(transitioned)-499.7(will)-501(likely)-497.7(already)-500.9(have)-496.3(a)]TJ
0 -1.1174 TD
[(medication)-442.3(regimen)-431.8(including)-437.7(estrogen,)-434.9(progester-)]TJ
0 -1.1116 TD
[(one,)-255.6(and)-257.9(an)-251(androgen)-258.8(blocker)-257.8(\(often)-255.5(spironolactone\))]TJ
T*
[(if)-440(they)-437.7(have)-444.5(not)-435.4(had)-436.4(a)-440(bilateral)-445.9(orchiectomy.)-441(De-)]TJ
0 -1.1174 TD
[(pending)-498.6(on)-491.8(the)-494.2(length)-491.8(of)-497.5(treatment,)-496.5(patients)-495.2(will)]TJ
0 -1.1116 TD
[(have)-553.9(growth)-554.8(of)-549.3(mammary)-555.1(tissue.)-552.5(When)-555(patients)]TJ
T*
[(desire)-337.1(to)-336.4(induce)-337.4(lactation,)-334.1(it)-336.5(has)-332.6(been)-335(assumed)-339.2(that)]TJ
0 -1.1174 TD
[(the)-494.2(hormonal)-495.1(milieu)-493.2(of)-491.7(pregnancy)-497.2(should)-490.4(be)-492.9(ap-)]TJ
0 -1.1116 TD
[(proximated)-464.1(for)-452.5(a)-457.3(similar)-459.5(period)-457.1(of)-451.4(time)-456.3(as)-458.2(in)-457.3(in-)]TJ
T*
[(duced)-307.3(lactation)-301.9(with)-305(nongestating)-303.7(people)-302.8(AFAB,)-304.2(or)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
[(ABM)-336(PROTOCOL)]TJ
53.0113 0 TD
(287)Tj
ET
endstream
endobj
55 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
9.843 0 0 9.843 94.507 725.1588 Tm
0 0 0 rg
0 Tc
0 Tw
[(3)-340.9(t)0(o)-336.4(6)-340.9(months.)-339.5(Doses)-347(of)-336.2(estrogen)-345.1(and)-344.3(progesterone)]TJ
0 -1.1174 TD
[(may)-305.2(be)-308.6(increased)-314(gradually)-306.2(as)-308.4(tolerated)-313.3(to)-307.6(812)-165.7(mg)]TJ
0 -1.1116 TD
[(estrogen)-362.4(and)-361.6(400)-170.3(mg)-360.5(progesterone)-367.9(daily)-358.3(during)-363.8(the)]TJ
T*
[(stimulation)-389.3(phase)-387.8(as)-389.1(in)-388.2(the)-390.5(Reisman)-386.6(case)-393.6(report.)]TJ
7.3823 0 0 6.5614 293.7259 696.6423 Tm
(33)Tj
9.843 0 0 9.843 94.507 681.3352 Tm
[(Risks,)-361.1(especially)-361.4(of)-365(blood)-357(clots)-363.8(with)-356.9(high)-361.6(doses)-363.4(of)]TJ
0 -1.1174 TD
[(estrogen,)-504.1(should)-501.9(be)-504.5(discussed.)-504.8(Laboratory)-509.9(testing)]TJ
0 -1.1116 TD
[(for)-297(serum)-307.2(levels)-302.7(has)-298(been)-306.2(done)-299.3(but)-302.9(may)-299.4(or)-301.7(may)-299.4(not)]TJ
T*
[(be)-377.7(useful)-382.1(in)-382.5(guiding)-376.6(therapy.)-382.2(A)-382.1(more)-381.1(useful)-376.3(guide)]TJ
0 -1.1174 TD
[(may)-357(be)-354.7(a)-359.4(patients)-358(symptoms)-356.6(of)-359.3(breast/chest)-357.7(chan-)]TJ
0 -1.1116 TD
[(ges.)-301.4(At)-302.7(this)-304(phase,)-304.8(many)-306.3(providers)-304.7(will)-305.2(recommend)]TJ
T*
[(stimulation)-464.2(of)-468.7(the)-465.4(nipples)-464(and)-465.2(areolae)-473.2(and)-465.2(gentle)]TJ
0 -1.1174 TD
[(hand)-333.9(expression)-335.6(one)-332.8(to)-336.4(three)-336.2(times)-336.3(per)-332.7(day.)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 81.9779 593.6313 Tm
(B)Tj
/F6 1 Tf
9.843 0 0 9.843 94.507 593.6313 Tm
[(Prolactin)-375.3(promotion:)-381.2(Prolactin)-375.3(promotion)-380(is)-376.5(gener-)]TJ
0 -1.1116 TD
[(ally)-345.6(achieved)-353.4(with)-345.4(galactogogues)-353.1(and)-350(may)-345.5(be)-348.9(used)]TJ
T*
[(during)-432.9(the)-436.6(hormonal)-437.5(stimulation)-435.4(phase)-439.6(\(above\))-436.2(or)]TJ
0 -1.1174 TD
[(the)-436.6(expression)-445(phase)-439.6(\(below\).)-439.5(Traditional)-442.4(induced)]TJ
0 -1.1116 TD
[(lactation)-422.9(protocols)-420(use)-419(these)-422.5(medications)-426(through-)]TJ
T*
[(out)-423.9(the)-419.3(induced)-430.6(lactation)-422.9(process,)-427.7(although)-424.9(this)-424.9(is)]TJ
0 -1.1174 TD
[(not)-320.2(evidence)-324.6(based.)-322.1(Domperidone)-321.9(has)-321.1(the)-321.4(strongest)]TJ
0 -1.1116 TD
[(evidence)-261.3(for)-262.4(successful)-267.4(lactation)-267.3(promotion,)-262.5(and)-257.9(the)]TJ
T*
[(only)-511.4(published)-512.2(case)-514.5(report)-508.9(of)-514.8(successful)-515.1(induced)]TJ
0 -1.1174 TD
[(lactation)-376.8(is)-376.5(in)-376.7(a)-376.6(transgender)-378.3(woman)-377.4(who)-378.6(used)-374(this)]TJ
0 -1.1116 TD
(medication.)Tj
7.3823 0 0 6.5614 140.9385 488.4093 Tm
(33)Tj
9.843 0 0 9.843 151.3133 484.0439 Tm
[(It)-307.6(is)-301.6(not)-302.9(FDA)-304.4(approved)-304.9(for)-308.5(use)-303.8(in)-301.8(the)]TJ
-5.7712 -1.1116 TD
[(United)-481.2(States.)-484.6(Metoclopramide)-483.4(or)-480.2(herbal)-481.3(galacto-)]TJ
0 -1.1174 TD
[(gogues)-295.6(may)-299.4(also)-293.5(be)-297.1(attempted.)-300.7(Cost,)-296.8(risks,)-296.6(and)-298.2(side)]TJ
0 -1.1116 TD
[(effects)-523.7(of)-520.5(some)-519.2(treatments)-522.8(may)-524.1(limit)-519.9(a)-520.6(patients)]TJ
T*
[(ability)-331.9(to)-336.4(take)-335.2(these)-336.1(in)-336.4(the)-332.9(long)-332.8(term.)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 81.9779 429.2786 Tm
(B)Tj
/F6 1 Tf
9.843 0 0 9.843 94.507 429.2786 Tm
[(Expression:)-239(In)-232.6(general,)-239.4(withdrawal)-240.1(of)-238.3(the)-235(high)-234.9(doses)]TJ
0 -1.1174 TD
[(of)-336.2(estrogen)-339.3(and)-332.8(progesterone)-339.1(during)-340.8(the)-332.9(expression)]TJ
0 -1.1116 TD
[(phase)-526(should)-530.7(occur)-531.9(a)-526.4(month)-531(before)-527.2(a)-532.2(child)-525.3(will)]TJ
T*
[(need)-312(to)-307.6(be)-308.6(fed.)-313.1(A)-307.2(patient)-315.7(may)-311(resume)-309.4(their)-312.2(original)]TJ
0 -1.1174 TD
[(estrogen)-235.7(and)-234.9(progesterone)-235.5(dosages.)-237.7(Alternatively,)-241.6(as)]TJ
0 -1.1116 TD
[(in)-607.1(the)-615.1(Reisman)-611.2(case)-612.5(report,)]TJ
7.3823 0 0 6.5614 215.9432 378.8219 Tm
(33)Tj
9.843 0 0 9.843 229.3228 374.4566 Tm
[(estrogen)-615.8(may)-610.5(be)]TJ
-13.6966 -1.1116 TD
[(lowered)-581.2(even)-576.9(further)-579.1(\(0.025)-170.2(mg)-579.4(estradiol)-576.9(patch\).)]TJ
0 -1.1174 TD
[(Side)-328.1(effects)-327.8(of)-324.7(lowering)-327.9(estrogen)-333.6(to)-324.9(this)-327(level)-324.9(must)]TJ
0 -1.1116 TD
[(be)-308.6(considered)-313.9(if)-307.6(a)-313.3(patient)-309.9(has)-309.5(been)-312(well)-312(maintained)]TJ
T*
[(at)-677.4(higher)-681.8(levels)-677.1(previously.)-678(During)-681.5(this)-678.4(phase,)]TJ
T*
[(consistent)-307.1(hand)-299.3(expression)-306.8(and)-304(pumping)-302.8(are)-305.1(begun,)]TJ
0 -1.1174 TD
[(and)-338.5(should)-346.4(be)-337.4(gradually)-346.5(increased)-348.5(to)-336.4(510)-344.2(minutes)]TJ
0 -1.1116 TD
[(68)-256.7(times)-261.4(per)-263.6(day.)-261.3(Flange)-262.3(tting)-260.3(and)-257.9(pump)-259.1(teaching)]TJ
T*
[(should)-346.4(be)-348.9(done)-345.4(by)-347.8(a)-347.8(trained)-350.1(professional.)-352.8(Pumping)]TJ
0 -1.1174 TD
[(without)-262.4(expressing)-266.5(milk)-265.1(may)-264.9(be)-262.5(uncomfortable,)-264.6(and)]TJ
0 -1.1116 TD
[(lubricants)-387.9(can)-385.8(be)-383.5(used)-385.5(in)-382.5(the)-384.7(anges)-383(\(such)-386.6(as)-383.3(lan-)]TJ
T*
[(olin,)-388.2(coconut)-390.3(oil,)-387.1(or)-393.8(lubrication)-389.3(sprays)-393.3(specic)-391.1(for)]TJ
0 -1.1174 TD
[(pumping\))-367.2(to)-370.9(decrease)-377.3(friction.)-370.8(If)-370.8(milk)-374.5(is)-370.8(not)-366.3(being)]TJ
0 -1.1116 TD
[(used,)-331.3(it)-336.5(can)-333.9(be)-337.4(frozen)-337.2(in)-330.6(capped)-338.4(syringes.)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 81.9779 221.0456 Tm
(B)Tj
/F6 1 Tf
9.843 0 0 9.843 94.507 221.0456 Tm
[(If)-480.2(a)-480.3(child)-485(is)-480.2(being)-479.1(put)-481.5(to)-480.4(breast/chest)-490.1(during)-479(the)]TJ
0 -1.1174 TD
[(expression)-318.3(phase,)-322.1(without)-320(or)-319(before)-319.9(a)-319(full)-321.4(supply)-317.6(is)]TJ
0 -1.1116 TD
[(created,)-384.5(a)-376.6(supplement)-8.9(al)-377.9(feeding)-384.5(tube)-380.1(at)-377.9(the)-384.7(breast/)]TJ
T*
[(chest)-434(may)-431.9(be)-429.6(used)-431.6(to)-434.3(encourage)-435(the)-430.8(child)-433.1(to)-428.5(stay)]TJ
T*
(latched.)Tj
/F8 1 Tf
7.9702 0 0 7.9702 72 167.5275 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 80.9008 166.2236 Tm
[(Bonding)-538.8(should)-536.4(be)-533.3(discussed)-541.7(as)-538.8(a)-537.9(benet)-538.8(to)-538(chest-)]TJ
T*
[(feeding)-326.9(and)-327(breast)-8.8(feeding.)-324.6(Feeding)-332.6(or)-324.7(soothing)-331.4(a)-324.8(child)]TJ
T*
[(with)-345.4(ones)-346.3(body)-350(has)-344.1(been)-346.6(report)-7.8(ed)-343.2(to)-347.9(be)-348.9(of)-342(signicant)]TJ
0 -1.1174 TD
[(value)-336.3(by)-330.5(many)-335.1(people)-337.4(with)-333.8(low)-332.6(milk)-334.2(production.)]TJ
-.9043 -1.1116 TD
[(Some)-294.6(parents)-303.7(may)-293.7(consider)-299(colactation)-305.3(after)-295.9(one)-298.2(or)-295.9(more)]TJ
T*
[(parents)-384.3(induce)-389.2(lactation,)-386(or)-382.3(because)-392.3(one)-384.6(parent)-383.4(has)-384.4(pre-)]TJ
0 -1.1174 TD
[(viously)-416.7(fed)-413.4(a)-417(prior)-420.3(child)-415.9(or)-416.9(is)-411.1(still)-420.5(lactating)-417.1(when)-415.4(their)]TJ
0 -1.1116 TD
[(partner)-488.2(gives)-484.7(birth.)-481.5(In)-486(addition,)-486.1(there)-486(are)-489.4(families)-484.8(and)]TJ
T*
[(relationships)-373.8(with)-379.9(more)-369.6(than)-374.3(two)-378.7(parents)-372.8(and,)-376.5(therefore,)]TJ
0 -1.1174 TD
[(colactation)-662.4(may)-656.5(refer)-658.6(to)-653.2(milk)-656.7(sharing)-659.6(among)-658.8(larger)]TJ
0 -1.1116 TD
[(groups.)-332.4(If)-336.2(a)-330.6(family)-337.5(is)-336.2(considering)-337(colactation:)]TJ
26.5177 67.9184 TD
[(1.)-499.9(Discuss)-337.6(expectations)-340.6(and)-332.8(goals)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 342.992 715.4644 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 351.8928 714.1605 Tm
[(Inform)-554.9(parents)-557.1(that)-558.8(colactation)-558.7(experiences)-565(are)]TJ
0 -1.1116 TD
[(unlikely)-430.8(to)-428.5(decrease)-440.6(the)-430.8(workload)-431.4(for)-435.2(the)-430.8(gesta-)]TJ
T*
[(tional)-330.7(parent.)-329.3(This)-333.8(may)-328.2(be)-331.7(a)-330.6(misconception)-336(about)]TJ
T*
(colactation.)Tj
/F8 1 Tf
7.9702 0 0 7.9702 342.992 671.6407 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 351.8928 670.3369 Tm
[(Other)-335.9(duties)-341.9(\(including)-340.8(chores,)-346.2(work/income,)-342.8(and)]TJ
T*
[(infant)-393.9(care\))-394.8(should)-392.4(be)-395(discussed)-391.9(and)-396.1(any)-390.4(family/)]TJ
T*
[(community)-422.7(resources)-427.7(available)-429.7(should)-427(be)-423.8(identi-)]TJ
0 -1.1174 TD
[(ed,)-330.3(especially)-338.4(for)-337.3(the)-332.9(rst)-338.2(2)-329.4(weeks)-336.8(after)-336.2(birth.)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 342.992 627.8171 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 351.8928 626.5132 Tm
[(Di)19.8(sc)19.9(us)21(s)-415.6(p)0(a)19.7(r)0(e)19.7(n)0(t)20.7(a)0(l)-400.9(g)0(o)15.1(a)0(l)19.5(s)-409.8(fo)20.9(r)-415.8(c)0(o)19.7(l)0(a)19.6(c)0(t)19.5(a)0(t)19.5(i)0(n)20.7(g)0(.)-402(S)0(o)15.2(m)0(e)-402(s)0(p)21(e)0(-)]TJ
0 -1.1116 TD
[(ci)19.6(c)-256.6(qu)15.1(es)19.9(ti)20.6(on)20.8(s)-271.6(f)0(o)20.9(r)-271.8(pa)19.7(re)19.7(nt)20.7(s)-271.6(t)0(o)-261.5(c)0(o)19.7(n)0(s)21(i)0(d)14.9(e)0(r)-256.8(a)0(r)19.7(e)0(:)-262.7(w)0(h)20(o)-271.8(wi)19.8(ll)]TJ
0 -1.1174 TD
[(do)-382.3(sk)21(in)20.7(-t)20.7(o-)15.1(sk)21(in)-382.5(at)-383.6(bi)20.7(rt)20.7(h,)-384.7(wh)20(o)-392.7(w)0(i)19.8(l)0(l)-382.6(f)0(e)19.7(e)0(d)-383.5(a)0(n)19.7(d)-392.8(wh)20(en)13.9(,)]TJ
0 -1.1116 TD
[(an)19.7(d)-231.5(h)0(o)20.8(w)-232.4(wi)19.8(ll)-227.1(mu)19.6(lt)20.6(ip)20.7(le)-222.4(mi)19.5(lk)-221.2(su)15.3(pp)20.8(li)20.6(es)-222(be)-228(ma)18.4(in)20.7(ta)19.6(in)20.7(ed)19.7(?)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 342.992 583.9935 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 351.8928 582.6896 Tm
[(Appendix)-270.2(A1)-273.8(offers)-272.4(a)-273(sample)-275.1(colactation)-276.5(plan)-276.4(that)]TJ
T*
[(can)-328.2(be)-325.9(adapted)-333.9(for)-325.8(individual)-329.5(parents)-332.5(and)-327(may)-328.2(be)]TJ
0 -1.1174 TD
[(created)-335(and)-332.8(shared)-337(with)-333.8(providers)-339.3(before)-337.2(birth.)]TJ
-1.918 -1.1116 TD
[(2.)-499.9(Support)-336(milk)-334.2(production)-335(and)-332.8(infant)-336.3(health)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 342.992 540.1133 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 351.8928 538.866 Tm
[(All)-332.7(lactating)-330.7(parents)-338.2(will)-334(need)-329.3(to)-336.4(maintain)-335.3(a)-330.6(milk)]TJ
0 -1.1174 TD
[(supply)-334.8(by)-330.5(feeding)-338.4(or)-330.5(expressing)-341.4(milk.)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 342.992 518.2298 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 351.8928 516.9258 Tm
[(Support)-474.2(milk)-472.4(production)-473.2(in)-474.6(all)-477(lactating)-474.7(parents)]TJ
0 -1.1116 TD
[(with)-414.5(removal)-420.3(of)-411.1(milk)-414.8(six)-417.9(to)-417(eight)-415.9(times)-416.9(per)-419.1(day)]TJ
0 -1.1174 TD
[(and)-407.6(galactogogues,)-408.4(as)-412.1(detailed)-410.1(in)-405.5(ABM)-409.3(Protocol)]TJ
0 -1.1116 TD
(#9.)Tj
7.3823 0 0 6.5614 364.1952 488.4093 Tm
(37)Tj
/F8 1 Tf
7.9702 0 0 7.9702 342.992 474.4062 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 351.8928 473.1022 Tm
[(When)-497.4(possible,)-502.9(consider)-500.6(prioritization)-508(of)-497.5(colos-)]TJ
0 -1.1174 TD
[(trum)-512.6(feeding)-517(with)-518.1(the)-517.2(gestational)-517(parent,)-519.3(given)]TJ
0 -1.1116 TD
[(the)-563.3(individuality)-563.4(of)-560.9(colostrum)-565.3(for)-561.9(the)-563.3(neonate.)]TJ
T*
[(Colostrum)-329(is)-330.4(produced)-327.9(in)-330.6(the)-327.1(birth)-328.3(parent)-331.6(starting)]TJ
T*
[(in)-330.6(the)-332.9(second)-337(trimester)-341.9(of)-330.5(pregnancy.)]TJ
7.3823 0 0 6.5614 502.4125 433.644 Tm
(39)Tj
9.843 0 0 9.843 323.0361 418.2802 Tm
[(Situations)-369.4(of)-365(adoption)-361.6(or)-365(surrogacy)-369.1(may)-362.8(be)-366.2(complicated)]TJ
-1.0137 -1.1116 TD
[(by)-342(a)-347.8(birth)-339.8(taking)-342.1(place)-348.9(in)-336.4(a)-347.8(different)-340.7(area)-347.7(than)-339.8(the)-344.4(parents)]TJ
T*
[(home,)-292.5(at)-291.5(an)-285.6(unfamiliar)-291.4(hospital,)-290.1(or)-290.2(one)-286.7(with)-293.5(inadequate)-292.4(lac-)]TJ
0 -1.1174 TD
[(tation)-382.5(support)-382(for)-377.6(LGBTQ)]TJ
/F7 1 Tf
10.9319 0 TD
(+)Tj
/F6 1 Tf
.9273 0 TD
[(individuals.)-379.9(The)-380(breastfeeding)]TJ
-11.8592 -1.1116 TD
[(medicine)-249.9(provider)-252(can)-241.8(serve)-249.5(as)-245.1(an)-251(important)-243.1(mediator)-248.7(in)-250(this)]TJ
T*
[(interaction)-10.3(.)-279.9(I)0(n)-278.6(particular,)-283.2(before)-285.3(birth:)]TJ
/F8 1 Tf
7.9702 0 0 7.9702 323.0361 342.8787 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 331.9369 341.5747 Tm
[(Co)19.8(ns)15.3(id)20.7(er)-452.6(te)13.8(st)20.9(in)20.7(g)-467.6(f)0(o)20.9(r)-467.6(tr)20.7(an)19.7(sm)19.8(is)20.9(si)15.1(bl)20.7(e)-468.8(i)0(n)20.7(f)0(e)19.7(c)0(t)19.5(i)0(o)20.7(n)0(s)-457(w)0(h)20(e)0(n)-458.4(i)0(n)20.7(-)]TJ
T*
[(du)20.8(ci)19.5(ng)-474.5(la)19.6(ct)19.5(at)19.5(io)20.7(n)-479.1(o)0(r)-474.5(a)-480.3(no)20.8(ng)20.8(es)19.9(ta)19.5(ti)20.6(on)15.1(al)-470(pa)19.7(re)19.7(nt)-468.9(de)19.7(si)15.1(re)19.7(s)-479(t)0(o)]TJ
T*
[(gi)20.7(ve)-562.1(th)20.7(ei)19.5(r)-571.3(m)0(i)19.5(l)0(k)20.7(.)-567.9(Th)19.6(es)14.1(e)-566.7(l)0(a)19.5(b)0(o)20.8(r)0(a)14(t)0(o)20.7(r)0(i)20.7(e)0(s)-561.9(a)0(r)19.7(e)-572.5(ro)20.9(ut)20.7(in)20.7(el)19.6(y)-571.3(r)0(e)19.7(-)]TJ
0 -1.1174 TD
[(co)19.7(mm)18.4(en)19.7(de)19.7(d)-266(i)0(n)-255.8(p)0(r)15.1(e)0(n)19.7(a)0(t)19.5(a)0(l)-256.9(c)0(a)18.5(r)0(e)-256.8(a)0(n)19.7(d)0(,)-258(a)0(s)-256.6(s)0(u)21(c)0(h)19.7(,)-268.4(se)19.9(rv)20.9(e)-267.2(t)0(o)-255.7(g)0(u)20.8(i)0(d)20.7(e)]TJ
0 -1.1116 TD
[(bo)20.8(th)-232.7(pr)20.9(eg)19.7(na)13.9(nc)19.7(y)-237.2(a)0(n)13.9(d)-237.2(la)19.6(ct)13.8(at)19.5(io)20.7(n)-243(m)0(a)18.4(n)0(a)19.7(g)0(e)19.7(m)0(e)18.4(n)0(t)20.7(.)-239.6(In)-232.6(ad)19.7(di)15(ti)20.6(on)20.8(,)-239.6(a)]TJ
T*
[(bi)20.7(rt)15(h)-358.2(h)0(o)20.8(s)0(p)15.3(i)0(t)20.6(a)0(l)-354.8(m)0(a)18.4(y)-358.2(re)14(qu)20.8(ir)20.7(e)-365.1(t)0(h)20.7(a)0(t)-354.8(a)-359.4(pa)19.7(re)14(nt)-347.9(ha)13.9(ve)-348.9(sc)14.1(re)19.7(en)19.7(in)20.7(g)]TJ
0 -1.1174 TD
[(la)19.5(bo)20.8(ra)14(to)20.7(ri)20.7(es)-383.3(be)19.7(fo)20.9(re)-383.5(al)19.5(lo)20.7(wi)19.8(ng)-382.3(th)20.7(ei)19.5(r)-392.7(m)0(i)19.5(l)0(k)-382.5(t)0(o)-376.7(b)0(e)-383.5(p)0(r)20.9(o)0(v)20.8(i)0(d)20.7(e)0(d)13.9(.)]TJ
0 -1.1116 TD
[(Th)19.6(e)-342.1(f)0(o)20.9(l)0(l)20.6(o)0(w)14.2(i)0(n)20.7(g)-340.9(m)15(a)0(y)-331.7(b)0(e)-331.7(c)0(o)19.7(n)0(s)15.3(i)0(d)20.7(e)0(r)19.7(e)0(d)19.7(:)-341.1(HI)20(V,)-333.7(sy)21(ph)20.8(il)20.6(is)20.9(,)-343.2(h)0(e)19.7(p)0(a)19.7(-)]TJ
T*
[(ti)20.6(ti)14.8(s)-375.3(B)-376.5(an)19.7(d)-375.5(C)-376.5(\(t)15(o)-375.5(p)0(r)20.9(o)0(v)20.8(i)0(d)20.7(e)-382.4(co)19.7(un)20.8(se)19.9(li)20.6(ng)-370.8(in)-365.2(th)20.7(e)-376.6(i)0(n)20.7(s)0(t)15.1(a)0(n)19.7(c)0(e)-367.4(o)0(f)]TJ
0 -1.1174 TD
[(bl)20.7(ee)18.5(di)14.9(ng)-324.7(ni)20.7(pp)20.8(le)19.6(s/)15.1(bl)20.7(oo)20.8(d)-335.2(i)0(n)-330.6(t)0(h)20.7(e)-336.3(mi)19.5(lk)20.7(\),)-327(an)19.7(d)-340.9(t)0(u)20.7(b)0(e)19.7(r)0(c)19.7(u)0(l)20.7(o)0(s)15.3(i)0(s)-324.7(i)0(n)]TJ
0 -1.1116 TD
[(hi)20.7(gh)15.1(-r)20.9(is)20.9(k)-421.6(a)0(r)13.9(e)0(a)18.5(s)0(.)-413.3(C)0(y)19.8(t)0(o)20.7(m)0(e)18.4(g)0(a)19.7(l)0(o)20.7(v)0(i)20.7(r)0(u)15.1(s)-421.4(te)19.5(st)20.9(in)14.9(g)-421.6(o)0(f)-411.1(g)0(e)19.7(s)0(t)15.1(a)0(t)19.6(i)0(o)20.7(n)0(a)19.7(l)]TJ
T*
[(pa)19.7(re)19.7(nt)14.9(s)-392.6(a)0(n)19.7(d)0(/)20.7(o)0(r)-388.1(h)0(u)20.8(m)0(a)18.4(n)-398.5(mi)19.5(lk)-382.5(is)-388(pe)19.7(rf)20.9(or)20.9(me)18.4(d)-398.5(i)0(n)-382.5(s)0(o)15.3(m)0(e)-384.7(n)0(e)19.7(o)0(-)]TJ
0 -1.1174 TD
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(2016;1:99107.)Tj
-1.7505 -1.1284 TD
[(20.)-500.5(Moravek)-267.2(MB.)-260.6(Fertility)-264(preservation)-267(options)-261.3(for)-261.2(transgender)]TJ
1.7505 -1.1223 TD
[(and)-407.2(gender-nonconforming)-408.1(individuals.)]TJ
/F5 1 Tf
16.6143 0 TD
[(Curr)-406.1(Opin)-404.1(Obstet)]TJ
-16.6143 -1.1284 TD
(Gynecol)Tj
/F6 1 Tf
3.6778 0 TD
(2019;31:170176.)Tj
-5.4283 -1.1223 TD
[(21.)-500.5(Abramowitz)-410.2(J,)-401.9(Tangpricha)-408.1(V.)-404.3(Hormonal)-404.7(management)-413.3(for)]TJ
1.7505 -1.1284 TD
[(transfeminine)-510.1(individuals.)]TJ
/F5 1 Tf
11.2348 0 TD
[(Clin)-498.2(Plast)-506.8(Surg)]TJ
/F6 1 Tf
7.1788 0 TD
(2018;45:313)Tj
-18.4136 -1.1223 TD
(317.)Tj
-1.7505 -1.1284 TD
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1.7505 -1.1223 TD
[(after)-373.1(fertility)-379.3(preservation)-370.7(in)-371.8(transgender)-377.3(men.)]TJ
/F5 1 Tf
19.4871 0 TD
[(Obstet)-376.7(Gy-)]TJ
-19.4871 -1.1284 TD
(necol)Tj
/F6 1 Tf
2.5129 0 TD
(2017;129:10311034.)Tj
-4.2634 -1.1223 TD
.0198 Tc
[(2)19.8(3)19.8(.)-480.7(Ellis)-339.3(S)4.6(A,)-340.1(Dalke)-338.3(L)-.5(.)-340.1(M)2.1(idwif)5.1(e)-2.8(ry)-334.1(care)-338.3(for)-342.5(t)1.9(ransf)5.1(e)-2.8(minine)-338.3(in-)]TJ
1.7505 -1.1284 TD
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4.7147 0 TD
[(J)-595.5(M)-2.1(idw)-4.4(ifery)-595.5(Womens)-596.5(Heal)-5.2(th)]TJ
/F6 1 Tf
13.4915 0 TD
.0184 Tc
[(2019;64:)-5.6(298)]TJ
-18.2062 -1.1223 TD
[(311)-6.1(.)]TJ
-1.7505 -1.1284 TD
0 Tc
[(24.)-500.5(Wierckx)-344.9(K,)-343.4(Gooren)-338.3(L,)-343.7(TSjoen)-341.1(G.)-343.4(Clinical)-341.4(review:)-347.6(Breast)]TJ
1.7505 -1.1223 TD
[(development)-250.5(in)-237.6(trans)-243.7(women)-243.9(receiving)-246.9(cross-sex)-249.6(hormones.)]TJ
/F5 1 Tf
0 -1.1284 TD
[(J)-333.7(Sex)-338.2(Med)]TJ
/F6 1 Tf
4.6293 0 TD
(2014;11:12401247.)Tj
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[(25.)-500.5(TSjoen)-408.2(G,)-410.4(Arcelus)-408.3(J,)-408(Gooren)-411.5(L,)-404.7(et)-406.5(al.)-412.6(Endocrinology)-405.6(of)]TJ
1.7505 -1.1284 TD
[(transgender)-340.7(medicine.)]TJ
/F5 1 Tf
9.283 0 TD
[(Endocr)-335.4(Rev)]TJ
/F6 1 Tf
5.1234 0 TD
(2019;40:97117.)Tj
10.8566 69.7752 TD
[(26.)-500.5(Kraut)-447.4(RY,)-445.9(Brown)-442.4(E,)-447.3(Korownyk)-445.8(C,)-444.1(et)-443.1(al.)-449.2(The)-445.7(impact)-446.9(of)]TJ
1.7505 -1.1223 TD
[(breast)-742.1(reduction)-736.7(surgery)-740.9(on)-738.3(breastfeeding:)-746.7(Systematic)]TJ
0 -1.1284 TD
[(review)-762.8(of)-765(observational)-764.4(studies.)]TJ
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15.0529 0 TD
[(PLoS)-761.7(One)]TJ
/F6 1 Tf
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(2017;12:)Tj
-20.408 -1.1223 TD
(e0186591.)Tj
-1.7505 -1.1283 TD
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1.7505 -1.1223 TD
[(gestational)-541.7(surrogacy.)]TJ
/F5 1 Tf
9.6246 0 TD
[(Semin)-536.6(Reprod)-536.7(Med)]TJ
/F6 1 Tf
9.2951 0 0 9.2951 498.2172 672.888 Tm
(2017;35:408)Tj
-18.4075 -1.1284 TD
(414.)Tj
-1.7505 -1.1223 TD
[(28.)-500.5(Light)-471.1(AD,)-473.2(Obedin-Maliver)-475.9(J,)-475.1(Sevelius)-474(JM,)-474.5(et)-473.6(al.)-473.6(Trans-)]TJ
1.7505 -1.1284 TD
[(gender)-456.9(men)-455.6(who)-459.5(experienced)-457.4(pregnancy)-461.5(after)-458.4(female-to-)]TJ
0 -1.1223 TD
[(male)-276.4(gender)-280(transitioning.)-285.3(Obstet)-279.1(Gynecol)-278.8(2014;124:1120)]TJ
0 -1.1284 TD
(1127.)Tj
-1.7505 -1.1223 TD
[(29.)-500.5(Hoffkling)-408.9(A,)-410.4(Obedin-Maliver)-414.9(J,)-414.1(Sevelius)-413(J.)-408(From)-414(erasure)]TJ
1.7505 -1.1284 TD
[(to)-432.8(opportunity:)-434.8(A)-428.7(qualitative)-438.3(study)-432.3(of)-435.6(the)-437.1(experiences)-438.2(of)]TJ
T*
[(transgender)-731(men)-730(around)-727.1(pregnancy)-729.9(and)-730.4(recommenda-)]TJ
0 -1.1223 TD
[(tions)-651.3(for)-651.6(providers.)]TJ
/F5 1 Tf
9.1001 0 TD
[(BMC)-656.1(Pregnancy)-655.4(Childbirth)]TJ
/F6 1 Tf
12.5888 0 TD
(2017;)Tj
-21.6889 -1.1284 TD
[(17\(Suppl)-329.1(2\):332.)]TJ
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[(30.)-500.5(MacDonald)-239.9(T,)-246.1(Noel-Weiss)-240.9(J,)-243.3(West)-239.4(D,)-245.8(et)-241.8(al.)-241.9(Transmasculine)]TJ
1.7505 -1.1284 TD
[(individuals)-438.1(experiences)-438.2(with)-434(lactation,)-438.7(chestfeeding,)-439.8(and)]TJ
0 -1.1223 TD
[(gender)-676.4(identity:)-673.6(A)-678.7(qualitative)-676.2(study.)]TJ
/F5 1 Tf
16.84 0 TD
[(BMC)-674.4(Pregnancy)]TJ
-16.84 -1.1284 TD
(Childbirth)Tj
/F6 1 Tf
4.5073 0 TD
(2016;16:106.)Tj
-6.2578 -1.1223 TD
[(31.)-500.5(Wolfe-Roubatis)-357.1(E,)-349.8(Spatz)-353(DL.)-357.6(Transgender)-355.3(men)-351.9(and)-352.3(lacta-)]TJ
1.7505 -1.1284 TD
[(tion:)-310.1(What)-319.6(nurses)-310.6(need)-314(to)-316.9(know.)]TJ
/F5 1 Tf
13.5952 0 TD
[(MCN)-311.3(Am)-314.8(J)-315.4(Matern)-317.1(Child)]TJ
-13.5952 -1.1223 TD
(Nurs)Tj
/F6 1 Tf
2.2689 0 TD
(2015;40:3238.)Tj
-4.0194 -1.1284 TD
[(32.)-500.5(Grover)-432.1(SA,)-437.9(Shmorgun)-432.9(Z,)-435.2(Moskovtsev)-435.6(SI,)-438.6(et)-437(al.)-430.9(Assisted)]TJ
1.7505 -1.1223 TD
[(reproduction)-501.6(in)-505.9(a)-504.5(cohort)-507(of)-502.7(same-sex)-507.9(male)-502(couples)-508.1(and)]TJ
0 -1.1284 TD
[(single)-332.4(men.)]TJ
/F5 1 Tf
5.038 0 TD
[(Reprod)-335.4(Biomed)-337.3(Online)]TJ
/F6 1 Tf
9.7405 0 TD
(2013;27:217221.)Tj
-16.5289 -1.1223 TD
.0232 Tc
[(3)23.2(3)23.2(.)-477.3(R)6.1(e).6(ism)5.2(a).6(n)-544.2(T)-3.2(,)-544.1(G)3.2(ol)5.3(ds)5.7(tein)-544.2(Z.)-544.1(Cas)5.6(e)-548.4(rep)4.8(o)-1.3(rt:)-543.6(I)2.4(nd)4.8(uce)6.7(d)-550.3(l)5.3(acta-)]TJ
1.7505 -1.1284 TD
.0215 Tc
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0 -1.1223 TD
.0184 Tc
[(24)-6.1(2)-6.1(6.)]TJ
-1.7505 -1.1284 TD
0 Tc
[(34.)-500.5(Appelgren)-415.6(Engstro)]TJ
9.0879 .0244 TD
()Tj
.4208 -.0244 TD
.4084 Tc
[(mH)408.4(,)-8.1(H)408.4(a)]TJ
3.3546 .0244 TD
0 Tc
()Tj
.3843 -.0244 TD
(ggstro)Tj
2.0859 .0244 TD
()Tj
.4147 -.0244 TD
[(m-Nordin)-415(E,)-416.9(Borneskog)]TJ
-13.9977 -1.1223 TD
[(C,)-474.6(et)-479.7(al.)-473.6(Mothers)-481.1(in)-475.4(same-sex)-477.4(relationships)-484.3(describe)-478.2(the)]TJ
0 -1.1284 TD
[(process)-491.8(of)-496.6(forming)-492.6(a)-492.3(family)-499.9(as)-491.5(a)-498.4(stressful)-494.3(journey)-494.9(in)-493.7(a)]TJ
0 -1.1223 TD
[(heteronormative)-320.4(world:)-320.8(A)-318.9(Swedish)-325.4(grounded)-318.8(theory)-317.9(study.)]TJ
/F5 1 Tf
0 -1.1284 TD
[(Matern)-335.4(Child)-333.7(Health)-334.9(J)]TJ
/F6 1 Tf
9.6856 0 TD
(2018;22:14441450.)Tj
-11.4361 -1.1223 TD
[(35.)-500.5(Wilson)-277.7(E,)-282.7(Perrin)-280.4(MT,)-282.1(Fogleman)-279.8(A,)-282.4(et)-278.4(al.)-284.6(The)-281(intricacies)-285.9(of)]TJ
1.7505 -1.1284 TD
[(induced)-246.7(lactation)-255.6(for)-249(same-sex)-251.8(mothers)-249.6(of)-246.6(an)-248.5(adopted)-252.8(child.)]TJ
/F5 1 Tf
0 -1.1223 TD
[(J)-333.7(Hum)-332.9(Lact)]TJ
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5.1661 0 TD
(2015;31:6467.)Tj
-6.9165 -1.1284 TD
[(36.)-500.5(Koutra)-551.2(K,)-556.8(Chatzi)-555.8(L,)-551(Bagkeris)-558.1(M,)-554.5(et)-552.9(al.)-552.9(Antenatal)-556.6(and)]TJ
1.7505 -1.1223 TD
[(postnatal)-348.7(maternal)-350(mental)-349.3(health)-349.7(as)-351.3(determinants)-349.1(of)-350.3(infant)]TJ
0 -1.1284 TD
[(neurodevelopment)-398.1(at)-400.4(18)-396.7(months)-401.5(of)-399.1(age)-399.2(in)-396.2(a)-400.8(mother-child)]TJ
0 -1.1223 TD
[(cohort)-616.8(\(Rhea)-614(Study\))-615.4(in)-615.7(Crete,)-619.6(Greece.)]TJ
/F5 1 Tf
17.6146 0 TD
[(Soc)-620.7(Psychiatry)]TJ
-17.6146 -1.1284 TD
[(Psychiatr)-332(Epidemiol)]TJ
/F6 1 Tf
8.6304 0 TD
(2013;48:13351345.)Tj
-10.3809 -1.1223 TD
[(37.)-500.5(Brodribb)-424.8(W.)-425.4(ABM)-426.9(Clinical)-426.8(Protocol)-430.3(#9:)-426.8(Use)-426.2(of)-423.4(galacto-)]TJ
1.7505 -1.1284 TD
[(gogues)-382.4(in)-377.9(initiating)-386.5(or)-380.8(augmenting)-386.4(maternal)-386.6(milk)-383.2(produc-)]TJ
0 -1.1223 TD
[(tion,)-377.7(second)-380.5(revision)-377.7(2018)]TJ
/F5 1 Tf
10.9542 0 TD
[(.)-378.2(Breastfeed)-379(Med)]TJ
/F6 1 Tf
7.4533 0 TD
(2018;13:307)Tj
-18.4075 -1.1284 TD
(314.)Tj
-1.7505 -1.1284 TD
[(38.)-500.5(Szucs)-438.1(KA,)-442.7(Axline)-444.7(SE,)-438.2(Rosenman)-446.1(MB.)-437.5(Induced)-444.8(lactation)]TJ
1.7505 -1.1223 TD
[(and)-486.5(exclusive)-487.6(breast)-492(milk)-480.8(feeding)-493(of)-484.4(adopted)-490.7(premature)]TJ
0 -1.1284 TD
(twins.)Tj
/F5 1 Tf
2.7508 0 TD
[(J)-333.7(Hum)-332.9(Lact)]TJ
/F6 1 Tf
5.1661 0 TD
(2010;26:309313.)Tj
-9.6673 -1.1223 TD
[(39.)-500.5(Sriraman)-400.4(NK.)-400(The)-396.9(nuts)-401.7(and)-395(bolts)-401.2(of)-399.1(breastfeeding:)-399.1(Anat-)]TJ
1.7505 -1.1284 TD
[(omy)-640.4(and)-651.2(physiology)-645.9(of)-643(lactation.)]TJ
/F5 1 Tf
15.4555 0 TD
[(Curr)-644(Probl)-647.7(Pediatr)]TJ
-15.4555 -1.1223 TD
[(Adolesc)-333.1(Health)-334.9(Care)]TJ
/F6 1 Tf
8.9049 0 TD
(2017;47:305310.)Tj
-10.6554 -1.1284 TD
[(40.)-500.5(Prendergast)-343.6(AJ,)-336.5(Goga)-341.8(AE,)-339.3(Waitt)-343(C,)-334.4(et)-339.4(al.)-345.6(Transmission)-341.4(of)]TJ
1.7505 -1.1223 TD
[(CMV,)-274.5(HTLV-1,)-278.6(and)-273(HIV)-280.4(through)-271.1(breastmilk.)]TJ
/F5 1 Tf
18.7369 0 TD
[(Lancet)-280(Child)]TJ
-18.7369 -1.1284 TD
[(Adolesc)-333.1(Health)]TJ
/F6 1 Tf
6.5689 0 TD
(2019;3:264273.)Tj
-8.3194 -1.1223 TD
[(41.)-500.5(Andersen)-244.4(AE,)-247.8(Moberg)-244.5(C,)-249(Bengtsson)-245.8(Tops)-245.6(A,)-245.8(et)-247.9(al.)-241.9(Lesbian,)]TJ
1.7505 -1.1284 TD
[(gay)-376.7(and)-376.7(bisexual)-379.6(parents)-384.8(experiences)-377.3(of)-380.8(nurses)-380.1(attitudes)]TJ
0 -1.1223 TD
[(in)-249.8(child)-253.8(health)-252.1(careA)-255.4(qualitative)-255.3(study.)]TJ
/F5 1 Tf
16.8217 0 TD
[(J)-254.4(Clin)-248.2(Nurs)]TJ
/F6 1 Tf
4.8672 0 TD
(2017;)Tj
-21.6889 -1.1284 TD
(26:50655071.)Tj
-1.7505 -1.1223 TD
[(42.)-500.5(Holmes)-328(A,)-331.2(McLeod)-333.7(AY,)-332.9(Bunik)-334.3(M.)-328.8(ABM)-329.3(clinical)-334.7(protocol)]TJ
1.7505 -1.1284 TD
[(#5:)-390.2(Peripartum)-394(breastfeeding)-393.4(management)-395(for)-389.3(the)-388.3(healthy)]TJ
0 -1.1223 TD
[(mother)-372.3(and)-370.6(infant)-372.2(at)-369.9(term,)-372.1(revision)-371.6(2013.)]TJ
/F5 1 Tf
17.5292 0 TD
[(Breastfeed)-372.9(Med)]TJ
/F6 1 Tf
-17.5292 -1.1284 TD
(2013;8:469473.)Tj
/F4 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
[(ABM)-336(PROTOCOL)]TJ
53.0113 0 TD
(291)Tj
ET
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1.7505 -1.1223 TD
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[(Com)6.2(m).1(it)6.3(tee)-449.8(o)-.3(n)-445.6(F)2.9(et)6.3(us)-450.8(an)5.8(d)-451.7(N)4.2(ewb)5.8(o)-.3(rn.)-445.5(D)-1.9(on)5.8(or)-447.9(hu)5.8(man)-445.6(m).1(ilk)]TJ
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0 -1.1223 TD
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[(e20)5.9(163)5.9(44)5.9(0.)]TJ
-1.7505 -1.1223 TD
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[(44.)-500.5(Coutsoudis)-448.6(I,)-453.9(Adhikari)-453.4(M,)-450.8(Nair)-447.3(N,)-453.1(et)-449.2(al.)-449.2(Feasibility)-454.4(and)]TJ
1.7505 -1.1284 TD
[(safety)-351.7(of)-344.2(setting)-350.3(up)-341.8(a)-352(donor)-344.6(breastmilk)-350.7(bank)-346.3(in)-347.4(a)-345.9(neonatal)]TJ
0 -1.1223 TD
[(prem)-378.7(unit)-383.7(in)-377.9(a)-382.5(resource)-383.5(limited)-380.6(setting:)-380.3(An)-380(observational,)]TJ
0 -1.1284 TD
[(longitudinal)-521.5(cohort)-519.2(study.)]TJ
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11.3873 0 TD
[(BMC)-521.9(Public)-518.2(Health)]TJ
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9.0269 0 TD
(2011;11:)Tj
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[(45.)-500.5(Palmquist)-261.5(AE,)-266.1(Doehler)-262.8(K.)-264.1(Human)-262.2(milk)-261.3(sharing)-262.2(practices)-268.5(in)]TJ
1.7505 -1.1223 TD
[(the)-333.4(U.S.)-334.3(Matern)-339.6(Child)-333.7(Nutr.)-333.3(2016;12:278290.)]TJ
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[(46.)-500.5(Sriraman)-369.9(NK,)-369.5(Evans)-371.9(AE,)-369.8(Lawrence)-377.5(R,)-364.9(et)-369.9(al.)-369.9(Academy)-374.6(of)]TJ
1.7505 -1.1284 TD
[(Breastfeeding)-453.1(Medicines)-452.8(2017)-451.9(position)-449.9(statement)-450(on)-451.6(in-)]TJ
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(2018;13:24.)Tj
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1.7505 -1.1284 TD
[(virtual)-316.9(lesbian)-318.5(parenting)-322(community.)]TJ
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15.3457 0 TD
[(J)-321.5(Lesbian)-317.7(Stud)]TJ
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(9:8194.)Tj
-1.7505 -1.1284 TD
[(48.)-500.5(Shakya)-280.5(P,)-277.6(Kunieda)-278.8(MK,)-275.7(Koyama)-284.9(M,)-273.9(et)-278.4(al.)-278.5(Effectiveness)-284.6(of)]TJ
1.7505 -1.1223 TD
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[(breastfeeding)-552(practices:)-554.7(A)-550.6(systematic)-546.9(review)-555.4(and)-547.5(meta-)]TJ
0 -1.1223 TD
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3.812 0 TD
[(PLoS)-334.7(One)]TJ
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(2017;12:e0177434.)Tj
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