Biology

Thalassaemia carrier rates vary by community of origin. Regional estimates put carrier rates in the Punjabi community at around 3 to 7 percent, Bangladeshi families at around 8 percent (a figure that rises further when HbE variants are included), Pakistani families at 4 to 6 percent, and Sri Lankan Tamil families at approximately 2.5 percent. These are estimates, not exact figures, but they are meaningful when you are planning a family.

If both parents carry the thalassaemia gene, there is a one in four chance that a child will have thalassaemia major. Universal antenatal haemoglobin screening has been offered to all pregnant women in England since 2007. If you are South Asian and planning a family but have not been screened, ask your GP for a haemoglobin electrophoresis test.

Consanguineous marriage, where partners are related, increases the chance that both carry the same recessive gene. Rates vary widely across South Asian communities and generations. If this applies to your family, a genetics counsellor can give you personal, non-judgmental guidance.

PMOS (formerly PCOS) affects an estimated 19 to 26 percent of South Asian women using Rotterdam diagnostic criteria, compared to 10 to 15 percent of White European women in the same studies (Ganie et al. 2024, ICMR Task Force). Some community-specific figures look higher still, but those often use broader "one or more PCOS features" criteria rather than the full diagnostic standard. The underlying driver is insulin resistance: South Asian metabolic biology means that insulin resistance can develop at a lower body weight and fat mass than European thresholds predict.

Type 2 diabetes follows a similar pattern. UK Biobank data shows that Bangladeshi people in the UK have a prevalence of around 29.9 percent, Pakistani people around 25 to 27 percent, and Indian people around 19 to 22 percent, compared to 8 to 10 percent in White British populations (UK Biobank data). The risk appears at a lower BMI, which means standard NHS screening thresholds miss people who need help.

Vitamin D deficiency also plays a role. A 2021 systematic review (Siddiqee et al.) found deficiency in 73 percent of people in Pakistan, 67 percent in Bangladesh and India, 57 percent in Nepal, and 48 percent in Sri Lanka. Vitamin D affects ovulation, implantation, and sperm health, so deficiency is not just a bone health concern.

Thalassaemia is a genetic blood condition more common in South Asian, Middle Eastern and Mediterranean families. In the UK, Punjabi and Bangladeshi communities have carrier rates of approximately 2-5%. NHS routine screening does not always offer this test proactively to these groups.

What to ask your GP or midwife

• "I'm South Asian - can I be tested for thalassaemia carrier status before we try to conceive?"
• "If I'm a carrier, does my partner need testing too?"
• "What does a carrier result mean for a pregnancy?"

If both partners are carriers, there is a 1-in-4 chance per pregnancy of a child with thalassaemia major. Prenatal diagnosis is available on the NHS.

The Parsi community is one of the smallest ethnic groups in South Asia, with under 100,000 people worldwide. Centuries of marriage within the community have resulted in a founder effect: certain genetic conditions are significantly more common than in the general population.

Known elevated risks in the Parsi population include certain cancers, metabolic conditions, and neurological disorders. Before conceiving, Parsi couples are recommended to discuss genetic counselling with a clinical geneticist, not just a GP.

What to ask

• "We're Parsi, is there a genetic counselling referral we should consider before trying to conceive?"
• "Are there Parsi-specific carrier screening panels available privately?"

• South Asian women tend to reach menopause approximately 2 years earlier than White European averages.
• Perimenopause symptoms (irregular periods, hot flushes, mood changes, sleep disruption) may start in the early 40s.
• HRT is underused in South Asian women partly due to cultural misconceptions about "natural" ageing and concerns about side effects that are not evidence-based.

Key GP prompt

"I'm in my 40s and having irregular periods, could this be perimenopause? Can we discuss HRT options?"

• Testosterone deficit affects around 10 to 40 percent of men over 45; symptoms include fatigue, low mood, reduced muscle mass, and reduced libido.
• South Asian men are less likely to discuss these symptoms with a GP due to stigma around male vulnerability.
• Persistent low energy should prompt a hormonal panel (total testosterone, LH, FSH, prolactin) before any supplement.

Key GP prompt

"I've had persistent fatigue and low mood for months, can we check my hormone levels?"