Damp Nipples, could I be???

[valerie anne]

I have been using breast milk pumps for some time and I have put on lots of breast weight & volume (36 DD).

Normally I don't attach the collection cups, as they don't fit into my bra. But today, I had drips of something and felt quite heavy.

Am I on the point of lactation? If so, I am delighted as its been my goal as a sissy, but how do I control it?

I would like to feel wobbly during the day with a relief session in the evening. I'm told the more I get sucked, the more milk will come.

 

[she she]

Congratulations Valerie, I know you have been working on this project for a long time so it seems anyway.

[noleen111]

I'm told the more I get sucked, the more milk will come.

 

Congrats on reaching this point,

Yes, that is correct, the more you get sucked the more milk you will produce.

I also have achieved lactation before, it started out as a few drops and as time went on, I got a good flow of milk. when the flow is good, you must remember to pump regularly, but your breasts will feel uncomfortable when they are "full". You can get an infection if your breast stays full of milk too long. (its not a pleasant experience, I had a friend who got an infection, she says its painful)

I enjoyed lactation, I enjoyed the feeling of the pump doing its thing. I adopted a baby during on my times of lactation and I attempted breast feeding, the child did latch (it feels wonderful to feel the child sucking. But I never produced enough milk to feed the child fully, after about 2 weeks, the child needed more milk than mommy could produce.

[kat2]

I have nipple discharge, my doctor doubled my progesterone and thats when i started with that problem,it is like a weak milky colour ive had to go without wearing a bra due to it also being sticky. I have also become hyper sensitive around that area too

[Lori Dee]

I have nipple discharge, my doctor doubled my progesterone and thats when i started with that problem,it is like a weak milky colour ive had to go without wearing a bra due to it also being sticky. I have also become hyper sensitive around that area too

Progesterone is NOT the cause of nipple discharge. Prolactin is what causes the "milk ejection" reflex of the nipple.

Progesterone develops the mammary gland and increases the number of prolactin receptors while doing so. However, "the combination of estrogen and progesterone circulating in the blood appears to inhibit milk secretion by blocking the release of prolactin from the pituitary gland and by making the mammary gland cells unresponsive to this pituitary hormone."

Source: https://www.britannica.com/science/lactation

For causes of nipple discharge when not pregnant, see:
https://my.clevelandclinic.org/health/diseases/17924-galactorrhea

Galactorrhea (guh-lack-toe-REE-uh) happens when your breasts unexpectedly produce milk or a milk-like discharge. This nipple discharge may leak from your breast on its own or when touched. It's not related to milk production in breastfeeding or pregnancy. Galactorrhea sometimes indicates an underlying health condition, but is most often caused by too much prolactin. Prolactin is a hormone that triggers milk production. It's made by your pituitary gland, a gland at the base of your brain.

In Valerie Anne's case, it is likely caused by stimulation of the nipple, as she has been using a breast pump for several years.

[kat2]

Progesterone is NOT the cause of nipple discharge. Prolactin is what causes the "milk ejection" reflex of the nipple.

Progesterone develops the mammary gland and increases the number of prolactin receptors while doing so. However, "the combination of estrogen and progesterone circulating in the blood appears to inhibit milk secretion by blocking the release of prolactin from the pituitary gland and by making the mammary gland cells unresponsive to this pituitary hormone."

Source: https://www.britannica.com/science/lactation

For causes of nipple discharge when not pregnant, see:
https://my.clevelandclinic.org/health/diseases/17924-galactorrhea

Galactorrhea (guh-lack-toe-REE-uh) happens when your breasts unexpectedly produce milk or a milk-like discharge. This nipple discharge may leak from your breast on its own or when touched. It's not related to milk production in breastfeeding or pregnancy. Galactorrhea sometimes indicates an underlying health condition, but is most often caused by too much prolactin. Prolactin is a hormone that triggers milk production. It's made by your pituitary gland, a gland at the base of your brain.

In Valerie Anne's case, it is likely caused by stimulation of the nipple, as she has been using a breast pump for several years.

I am a great believer in what changed to make this happen, so for me the only thing that did change was the progesterone which was doubled, most likely this produced a knock on effect to a degree how our bodies respond depends upon many factors such as genetics and receptors

[Sarah B]

Hi Everyone

Kat you said the following:

I have nipple discharge, my doctor doubled my progesterone and thats when i started with that problem,it is like a weak milky colour ive had to go without wearing a bra due to it also being sticky. I have also become hyper sensitive around that area too

You are right in what you have said.

Introduction
Estrogen and progesterone, when administered together, can stimulate lactation like activity by promoting ductal growth and lobuloalveolar development in the breast.  This hormonal combination increases the sensitivity of breast tissue to prolactin, sometimes resulting in galactorrhea (milky nipple discharge) even when prolactin levels are normal.  This effect is a recognized physiological response during feminizing hormone therapy (Braunstein, 1993).

When talking about nipple discharge after upping the dose of progesterone, it's crucial to grasp how different hormones interact with breast tissue.  Sure, prolactin is the main hormone that kickstarts milk production and the milk ejection reflex, but estrogen and progesterone also play significant roles, especially for people undergoing feminizing hormone therapy.

Discussion
It's correct that progesterone does not directly trigger milk ejection.  In traditional reproductive physiology, high levels of estrogen and progesterone during pregnancy actually prevent active milk secretion until after childbirth when those hormone levels drop (Neville et al., 2002).  This is the scenario described in the Britannica source, which accurately outlines the postpartum lactation process.  However, this model focuses on pregnancy and does not fully apply to non pregnant individuals or those receiving exogenous hormone therapy.

For those on feminizing hormone therapy, estrogen encourages ductal growth and proliferation, while progesterone supports lobuloalveolar development, which lays the groundwork for secretory breast tissue (Russo & Russo, 2004).  When these hormones are used together, they boost the expression of prolactin receptors in breast tissue, making it more sensitive to both stable and fluctuating levels of prolactin (Hovey et al., 2002).  This is why galactorrhea spontaneous, milky discharge from the nipple might happen, even if there's no hyperprolactinemia present (Braunstein, 1993; Molitch, 2005).

So, saying "progesterone isn't responsible for nipple discharge" doesn't quite capture the whole picture in this context.  While it might not be the only factor at play, a sudden increase in progesterone, especially alongside ongoing estrogen therapy, can lead to changes in the breast that mimic lactation.  The milky, sticky and weak discharge described by kat2, along with hypersensitivity, aligns with this physiological process.  Even though prolactin is essential for lactation, progesterone boosts the breast's responsiveness to it, making hormonal changes a likely reason for the onset following a dosage adjustment.

Moreover, the suggestion that mechanical stimulation (like from a breast pump) might be the culprit relates to a different person's experience and does not apply here.  Kat2's scenario lacks any indication of breast stimulation, instead showing a clear time connection to hormone adjustments, which strongly hints at a pharmacological cause.

Personal Case Study
Personal History of Lactation
When I was pre-op I was given Premarin and Depo-Provera and I never worried about my breasts growing.  Sometime after surgery, I believe I was still receiving both hormones.  Not long after that, I noticed that I was lactating.  One memorable time, I was in the shower and I squeezed my breasts and milky substance was expressed and the quantity was substantial.  I do not know if it was sticky at the time.

After speaking with my doctor at the time, Depo-Provera was removed from my regimen.  My question at the time was simple.  Why was I lactating?  I knew instinctively that it was Depo-Provera.  It was not needed any more as testosterone was not being produced anymore!

Even if prolactin levels were not elevated in my case, my breast tissue may have become responsive enough to produce secretions simply due to the prolonged hormonal exposure.  Depo-Provera, being a potent synthetic progestin, likely enhanced the lobuloalveolar stimulation and pushed my breast tissue to a threshold where galactorrhea occurred.  After I reported the discharge to my doctor, Depo-Provera was removed from my hormone regimen and the symptoms eventually resolved. 

Hormonal Mechanism Behind Lactation
Lactation in my case was most likely the result of hormonal stimulation of the mammary glands due to the combination of Premarin (conjugated estrogens) and Depo-Provera (medroxyprogesterone acetate).  This combination mimics the hormonal environment of pregnancy in several ways, particularly in how it primes the breast for secretory activity by increasing prolactin receptor sensitivity, sometimes even resulting in galactorrhea without elevated prolactin (Hovey et al., 2002; Braunstein, 1993).

Estrogen and Progesterone Prepare the Breast for Lactation
Estrogen, such as that in Premarin, stimulates ductal growth in the breast tissue (Russo & Russo, 2004).  Progesterone, especially in the potent synthetic form found in Depo-Provera, promotes lobuloalveolar development, which is the structure involved in milk production (Neville et al., 2002).  When given together in sustained or high levels, these hormones increase prolactin receptor density in the breast (Hovey et al., 2002), essentially preparing the tissue to respond to even small amounts of prolactin, the hormone responsible for milk production.

Role Depo-Provera's
Depo-Provera is a long-acting synthetic progestin that is more potent and persistent than natural progesterone (Stanczyk et al., 1996).  It has been observed in some individuals to sensitize the mammary glands to circulating prolactin or even stimulate galactorrhea on its own when used with estrogen (Braunstein, 1993).  It does not directly raise prolactin levels but can amplify the breast's responsiveness to it (Molitch, 2005).

Surgical Influence
After surgery, especially if the testes have been removed, endogenous testosterone drops sharply and the body becomes even more sensitive to external hormones (Gooren & Giltay, 2008).  If estrogen and progestin are continued at the same or increased levels, the balance shifts and glandular tissue may reach a threshold of stimulation that triggers spontaneous lactation (Braunstein, 1993).

Withdrawal of Depo-Provera
My doctor likely recognized that Depo-Provera was the main contributor to the galactorrhea and removed it to reduce lobuloalveolar stimulation (Molitch, 2005).  Once Depo-Provera was stopped, the glandular activity likely diminished or ceased, especially if prolactin levels were normal and no other stimulants were present.

Conclusion
Although prolactin is key to milk secretion, the combination of estrogen and progesterone can create conditions that lead to galactorrhea.  This involves increased glandular development, greater sensitivity to prolactin receptors and active functions in the mammary tissue.  Therefore, the symptoms reported could very likely result from the recent increase in progesterone, especially within the framework of feminizing hormone therapy.

References:

• Braunstein, G.  D.  (1993).  Clinical review 36: Pathogenesis and evaluation of galactorrhea.  The Journal of Clinical Endocrinology & Metabolism, 77(3), 561–567.  https://doi.org/10.1210/jcem.77.3.8370694
• Gooren, L.  J., & Giltay, E.  J.  (2008).  Review of studies of androgen treatment of female-to-male transsexuals: effects and risks of administration of androgens to females.  Journal of Sexual Medicine, 5(4), 765–776.  https://doi.org/10.1111/j.1743-6109.2007.00743.x
• Hovey, R.  C., Trott, J.  F., & Vonderhaar, B.  K.  (2002).  Establishing a framework for the functional mammary gland: from endocrinology to morphology.  Journal of Mammary Gland Biology and Neoplasia, 7(1), 17–38.  https://doi.org/10.1023/A:1020346302956
• Molitch, M.  E.  (2005).  Disorders of prolactin secretion.  Endocrinology and Metabolism Clinics of North America, 34(3), 575–586.  https://doi.org/10.1016/j.ecl.2005.01.007
• Neville, M.  C., McFadden, T.  B., & Forsyth, I.  (2002).  Hormonal regulation of mammary differentiation and milk secretion.  Journal of Mammary Gland Biology and Neoplasia, 7(1), 49–66.  https://doi.org/10.1023/A:1020342914411
• Russo, J., & Russo, I.  H.  (2004).  Development of the human mammary gland.  Breast Cancer Research, 6(5), 244–251.  https://doi.org/10.1186/bcr921
• Stanczyk, F.  Z., Roy, S., & Overstreet, J.  W.  (1996).  Pharmacokinetics of medroxyprogesterone acetate after administration of Depo-Provera.  Contraception, 54(2), 71–77.  https://doi.org/10.1016/0010-7824(96)00111-1

Best Wishes Always
Sarah B
Global Moderator
@kat2 @Lori Dee @Northern Star Girl

[kat2]

You are right in what you have said.

Hi Sarah, I do not tend to go deep into the reasons just what caused the issue for me, and the only thing i could find was the doubling of progesterone, whether this was a correct or incorrect assumption doesnt really matter to me, we all respond in different ways and this is what happened in my case. I too was on a very high dosage of Premarin, but with Cyproterone, which again was high dosage which they do not recommend today.I am now on a combination of patches and progesterone (Utrogestan)thank you for your very informative write up.