: Some individuals use smoking as a way to affirm gender identity—for instance, viewing it as a "masculine" or "rebellious" trait. Conversely, stressors like internalized transphobia and targeted advertising by the tobacco industry contribute to higher rates.

Overview of feminizing hormone therapy - UCSF Transgender Care

: Tobacco use can interfere with estrogen therapy. It is known to potentially lower the effectiveness of oral estrogen and significantly increase the risk of dangerous blood clots.

Smoking poses unique health risks for transgender women, particularly those undergoing .

: Eroticized portrayals of smoking, often referred to as a smoking fetish , are prevalent in online media, frequently featuring "sexy" and young subjects. Medical Risks for Transgender Women

Research indicates that transgender and gender-expansive (TGE) adults are significantly more likely to smoke than cisgender individuals.

: Approximately 36% of TGE adults smoke cigarettes, compared to 21% of heterosexual cisgender adults.

: Transgender women on GAHT already face a higher incidence of venous thromboembolism, ischemic stroke, and myocardial infarction compared to cisgender peers; smoking further exacerbates these cardiovascular risks .