Transgender Women Who Begin Hormone Therapy More Likely to Quit Smoking

While there has been much concern about the potential harm from transgender medical intervention (hormone therapy), a new study has found that transgender women who receive hormone therapy are more likely to quit or decrease smoking cigarettes as compared to the general population.

The findings, which appear in the journal Endocrine Practice, is the first report of the potential for a dramatic decrease in tobacco use by transgender women who receive medical care at a medical facility.

According to the Centers for Disease Control, while 68 percent of adult smokers nationally desire to quit, only 6.2 percent successfully do in a given year. Transgender women seen for hormone therapy at Boston Medical Center (BMC) are strongly advised to quit smoking before the start of treatment, not only due to general health benefits, but also because of the concern for increased thromboembolic events (blood clots) with estrogen therapy. Transgender men are given the same recommendation regarding tobacco as any patient.

Researchers from BUSM sought to determine if the significant life change which occurs at the onset of hormone treatment along with counseling to cease smoking might provide impetus to quit among transgender women beyond that seen in the general population.

The medical records of 91 transgender women and 30 transgender men seen at the Center for Transgender Medicine and Surgery at BMC were retroactively examined and statistically analyzed. Of the twenty-eight transgender women who were current smokers when they began hormone treatment, 18 (64 percent) quit smoking over the course of initiating treatment. Of the 30 transgender men, 8 (27 percent) were current smokers when they began treatment. Of those, two (25 percent) quit smoking over the course of initiating treatment.

According to the researchers while discussing tobacco use with a healthcare provider can increase rates of smoking cessation, the substantially increased rate of smoking cessation among transgender women in this study suggests that a greater impact can be achieved when a life changing event is leveraged.

“The decrease in smoking was far greater among transgender women than among transgender men. We believe this relates to the fact that estrogen is considered a thrombosis risk and therefore standard initiation procedure includes minimizing other thrombosis risks like tobacco use. Transgender men do not receive the same message because testosterone is not associated with the same reported risk,” explained Joshua Safer, MD, associate professor of medicine at BUSM and director of the Center for Transgender Medicine and Surgery at BMC.

The researchers believe the data represents a striking demonstration of the potential health benefit from increased access to care for transgender individuals and further demonstrates the need for improved healthcare access for transgender individuals.