Author: Katie Kavanagh
Artist: Fion Lam
Editor: Sarah Gu
Science plays an ever-increasing role in our society. It penetrates multiple areas of life and affects many people. While numerous people are considered in scientific research, does it truly embody inclusivity for all? Science has a history of being male-dominated, and not taking women into consideration while carrying out research. In recent years, the number of women in STEM has been gradually increasing, however, a large group of people are yet to be included. Hannah Peckham has recently completed her PhD at UCL. In her project she attempted to address the issue of inclusivity in science by exploring the effects of gender and sex on the immune system.
The immune system is essential for maintaining our health. Its protective function fights off infections, from the common cold to the all-too-familiar COVID-19 virus. While this defensive feature is crucial for our health, problems can occur when our immune system is overprotective, leading to autoimmune disorders. In these disorders the immune system is hyperactive and attacks itself, which leads to conditions such as rheumatoid arthritis and lupus. The way our immune system works is not the same for everyone and varies due to characteristics such as sex. It appears that cisgender men are more likely to suffer severe outcomes when sick. In comparison, cisgender women appear to have a stronger immune system that can better fight off infections. However, with this strengthened immune system comes a higher likelihood of autoimmune disorders; lupus, for example, which is nine times more prevalent in cisgender women than in cisgender men.
In Hannah’s project, she investigated how the process of B cells in the immune system is influenced by gender and sex. B cells are cells of the immune system that produce antibodies, which are proteins that aid in fighting infections or toxins by recognising the specific antigen on the surface of the toxin, which they then mark for destruction. Interestingly, she investigated the effects of not just gender, but also sex, on these cells. Sex refers to the chromosomes we are born with, either XX for cisgender females, or XY for cisgender males, and often correlates to the gender we were assumed at birth. Gender, on the other hand, is more of a social construct, independent of chromosomes. For a large number of people this correlates with their hormones, oestrogen for cisgender women and transgender women who have received hormone therapy, and testosterone for cisgender men and transgender men who have received hormone treatment. When only cisgender males and females are included in research, the results are often limited as it remains unknown whether the impacts are dependent on chromosomes,hormones or a combination of both. However, by studying both transgender and cisgender men and women, this question can be answered.
The immune response carried out by the body varies in specificity throughout the process. In the first week the response is more general, or innate, in which the immune system acts as a barrier for toxins. Over the course of the first five to six days the immune system develops a more specific response, which enables it to better fight infection. The specialisation of the response is due to a process the B cells undergo called “class switching”. This enables them to produce a different type of antibody that is more specific to the infection they are fighting off. For example, IGG (Immunoglobulin G) antibodies are most desirable during a viral infection as they are good at fighting viruses. In an autoimmune disorder, this process goes wrong, and instead of ignoring the body, the antibodies recognise it as harmful and attack it. While It is desirable for B cells to class switch, enabling them to fight specific infections, this process can also result in more damage to the body in an autoimmune disorder. This impairment of class switching does not happen to the same extent in all individuals and appears to have a connection with sex and gender. Cisgender post-pubertal females have many more class switched B cells than cisgender post-pubertal males. This result is specifically related to cells of the class IGG, which are very effective at fighting off viruses but also cause a lot of damage in autoimmune disorders such as lupus.
During her research, Hannah investigated whether the difference in class switched B cell numbers was more dependent on sex or gender, i.e. on chromosomes or hormones. Young trans people who wish to undergo hormone replacement therapy initially begin with a puberty blocker, which suppresses the sex hormones natal to their body, of the gender which they do not identify with. After about a year, if eligible, they are able to start receiving new sex hormones – oestrogen for a trans woman, and testosterone for a trans man. These young trans people were attending UCLH for their treatment and participated in Hannah’s research. In cisgender females, the number of B cells is very high due to the highly active nature of their immune system. The number of B cells in cisgender males was significantly lower in comparison. When trans males had undergone the first stage of their hormone therapy, blocking oestrogen, the number of their class switched B cells decreased, closely emulating those of cisgender males. However, in trans women, when testosterone had been blocked and supplemented with oestrogen, there was not an increase to the level of cisgender females. These results suggest that there is a chromosomal component to these differences, as well as the suspected hormonal element.
The inclusion of gender diverse people in Hannah’s research is extremely valuable, yet rare. The lack of inclusivity is a common issue across scientific research. During the COVID pandemic, Hannah worked on a study investigating the prevalence of deaths and ICU admissions for different genders across the world. While carrying out this research, she discovered that only about two countries in the world presented data regarding trans people. The extent of the effort from other countries was adding an “other” category, to which Hannah asked “What does that mean? Nothing.” This research emphasised the extent of exclusion of trans people from research which she knows “needs to change”.
Science research that only includes cisgender males and females is outdated and unrepresentative of modern reality. Addressing the current lack of inclusivity can provide answers to the specific needs of people who were previously neglected, as well as enabling greater understanding of our bodies and the impacts of our gender and sex. In society, it is important not to emphasise the differences between transgender and cisgender people. Chromosomes, hormones, and anatomy are not direct correlates of gender and do not make someone any less part of their preferred gender. In science research and healthcare, gender diverse people have their own specific healthcare needs that must be addressed to prevent them from being neglected. The importance of sex and gender in society and research is becoming more recognised, however, it is still not routine to include these factors. If Hannah’s research serves to raise awareness that including gender diverse people in research is not as complicated as people would have you believe, then “that would be a win” for her.
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