Sex differences in asthma

[ArabellaScott]

A rant on Reddit from a male who identifies as a woman complaining that a 999 call handler asked for his sex (described at 'gender assigned at birth') when discussing symptoms.

https://www.reddit.com/r/transgenderUK/comments/1f9cq5s/had_to_just_call_999_as_asthma_was_terrifyingly/

Comments are furious at this 'transphobia'.

I checked, and guess what? Sex has a major impact:

'Asthma is a heterogenous disease, and its prevalence and severity are different in males versus females through various ages. As children, boys have an increased prevalence of asthma. As adults, women have an increased prevalence and severity of asthma. Sex hormones, genetic and epigenetic variations, social and environmental factors, and responses to asthma therapeutics are important factors in the sex differences observed in asthma incidence, prevalence and severity. For women, fluctuations in sex hormone levels during puberty, the menstrual cycle and pregnancy are associated with asthma pathogenesis. Further, sex differences in gene expression and epigenetic modifications and responses to environmental factors, including SARS-CoV-2 infections, are associated with differences in asthma incidence, prevalence and symptoms. '

www.ncbi.nlm.nih.gov/pmc/articles/PMC8783601/

I don't suppose anyone is keeping track of the health impacts on people who don't accurately report their sex when seeking care?

Our livers metabolise a lot of drugs more slowly, so it's easy to overdose a woman if you don't know her sex. Markers of kidney function have different ranges, so it could be the factor that means you do or don't get a transplant.

NitroNine chipped in very usefully with why it's sensible to have an agreed asthma plan and the sex differences.

iirc, the transman's treatment was related to a kidney problem and ultimately the need for a transplant.

In Whitley’s case, the problem was how the severity of kidney disease is assessed. The usual protocol is to calculate a patient’s “estimated glomerular filtration rate” (eGFR), which measures the amount of a certain waste product in their blood and therefore shows how efficient their kidneys are at filtering it out. If the eGFR is below a certain level, it’s an indication that their kidneys are failing and they are eligible for a transplant.
There are several different lower limits for an eGFR, depending on things like a person’s weight, age, gender and race, which are intended to reflect the natural variation in the human body. Based on the female cut-off, he would have been allowed a transplant immediately. But he’s registered as a man on his medical records, and this meant his doctors used the male eGFR level. He wasn’t put on the list until he reached it – a decision that ultimately delayed the surgery by over a year, and very nearly cost him his life.

www.mumsnet.com/talk/womens_rights/3999914-BBC-Article-about-why-Transgender-People-are-Ignored-in-Medicine

One thing I did pick up though is that it seems to be 'new' to be asked. They are interpreting that as transphobia, I am interpreting it as the NHS finally realising that if they choose not to confirm the sex of a patient, they may be held liable for any sex-inappropriate treatment they give.

And yet the article in the guardian a few years ago about transphobia within Gp health care was all about not recognising the sex differences and meeting need accordingly.

I realise this is making a serious thread all about me me me -
but I didn't know about the hormonal aspect of asthma until I read this, and now I think I understand why the very bad asthma I had as a child disappeared around the time my periods started.

I thought it was just a weird coincidence and a sick joke by my biology:
'We have good news and bad news. We're stopping your awful asthma that has blighted your childhood so far. But from now onwards you are going to have pain and discomfort every month for...let's see... well a good few decades anyway, sorry we don't do definite dates'😠

Ah, so the medical profession does sometimes make mistakes assigning sex at birth! Weren't we being told during the whole Khelif affair that the original determination is sacrosanct?

Not at all @MarieDeGournay; it's important to acknowledge how hormones affect asthma.

Hope I can be more me me me -Mine worsened post baby and into perimenopause which is when it was diagnosed.

I always did have the strange itchy bit under my neck with bad viruses that I still get now, which is when peak flow does dip. The worst reactions to viruses are always around a period too.

There was a bit of a campaign recently to get those links recognised.