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Hi. This was a response I had just made which may help you understand it better. At this point there are two camps. One thinks he's a beta that's been turned, while the other saying he's been misdiagnosed due to lack of visible omega traits, since he's so hyper-recessive.
This is what I have explained. Others may see or have learned things differently. I don't know how the law of this omegaverse works so I'm hung up myself. But maybe this will help.
https://www.mangago.zone/home/mangatopic/14961167/
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I'm only hazarding a guess that Ian doesn't like omegas - he hooked up with Noah cuz he's a beta and had said that it's better that you're a beta....and then when he's in rut he also produced such powerful pheromones that are full of a "scent filled with utter desolation" which I interpreted to mean that he's subconsciously anti-omega - maybe he had a bad experience w/ omegas before or something - idk - that pushes omegas away??? That's why the scent is so strong and painful?!? I mean it would explain A LOT about his reservations against having relationships with omegas. And he only hung out w/ alphas and betas at school too...
I really liked the part about the nosebleed that he had, it puts into perspective that changing second gender is an impactful thing, a rare effect. That the changes in bodies are very powerful Because even the adenoids in his nose have fallen out and What other crazy changes are happening in his body....I found the explanation of gender change when Beta becomes Omega so boring in other mangas, the explanation was so weak, that's why I really liked the bleeding that shows it's a crazy change.