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1) 1) Interesting interview of Dr. Audrey Ryback by David Tuller. Her recent study showed that there are likely two age peaks for when people get ME/CFS. It helps to characterise ME/CFS as a unique clinical entity.

Dr. Blome aka Dr. Strange

@blomechristine.bsky.social

6 May

Maybe there is one group of people who are extremely vulnerable to ME so that, for example, the first EBV infection is enough to trigger ME, and another group in whom cumulative harm is needed to reach the ME threshold (with the number of triggers needed typically reached after 35 years or so)?

ME/CFS Science

@mecfsscience.org

Yes but why does the risk drop between the peaks? Suggests the second peak isn't merely about cumulative harm

6/5/26, 12:38 pm0 reposts5 likes

H2oBio

@h2obio.bsky.social

6 May

Perhaps the risk is highest during life stages when the menstrual cycle is irregular (puberty, perimenopause)? 🤔

Dr. Blome aka Dr. Strange

@blomechristine.bsky.social

6 May

Yes, but then men would show less of the second peak, which I understood they don't.

H2oBio

@h2obio.bsky.social

6 May

If I had to guess, I'd say it's a cytokine that also fluctuates in response to hormonal changes, such as TNFalpha.

H2oBio

@h2obio.bsky.social

6 May

Three thoughts 1) Hormone levels also decline in men as they age. 2) I would be cautious about assuming that men don’t experience any monthly fluctuations at all (not necessarily hormonal). 3) Men experience a daily testosterone cycle

Dr. Blome aka Dr. Strange

@blomechristine.bsky.social

6 May

Because the first peak would be a different subgroup of ME who get it after only one trigger, or the first trigger during puberty, so most of these group would have it once they are adults. But this is really 100% speculation here.