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naraburns  nihil supernum  1yr ago (text post)   34909 thread views

Culture War Roundup for the week of March 13, 2023

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When a transperson undergoes medical treatment, which gender do they choose like for medication, dosing, etc.? The new one of the old one when it's a matter of life or death?

This is a good question. Men typically have higher levels of alcohol dehydrogenase than women. Are sex differences in liver enzymes determined by the genetic code of the liver cells themselves, or is this somehow hormone mediated? My guess would be that it's genetic, but eukaryotic gene regulation can be pretty complicated.

If you mean a difference in nucleotide sequence of the ADH

No, I didn't. I'm not an expert on genetics, but it seems plausible that there could be some gene on the Y chromosome which enhances ADH gene expression. However, after doing more research, I changed my mind. I think its more likely that sex differences in ADH expression are hormone mediated. Apparently it's stomach alcohol dehydrogenase which causes the sex difference in alcohol metabolism. The key quote:

"Young women below 50 years of age had significantly lower alcohol dehydrogenase activities in the gastric corpus and antrum when compared with age matched controls... Over 50 years of age this sex difference was no longer detectable, as high Km gastric alcohol dehydrogenase activity decreases with age only in men and not in women."

Looks testosterone-mediated to me.

Men also just have larger livers. Taking hormones isn’t going to change the size of an adults liver.

I've heard of anecdotal cases of doctors having to do averages of male and female dosing guidelines for certain medications when treating trans people. My guess is that it would have to be per medication, with some using the natal sex dosing, some using an average of some kind, and some using the dosing guidelines for the transitional sex. It's also not inconceivable that some might end up with wildly different dosing than either male or female because of something special about the particular set of medical interventions a trans person has.

We already know that hormone therapy often leads to increased risks in certain things (i.e. trans women have higher risk of breast cancer than cis men, but lower than cis women), so it's not surprising that there's going to be a lot of different answers around this.

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