Increased rates of smoking cessation observed among transgender women receiving hormone treatment

Objective: According to the Centers for Disease Control, while 68% of adult smokers nationally desire to quit, only 6.2% successfully quit 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 with estrogen therapy. Transgender men are given the same recommendation regarding tobacco as any patient. Methods: We retrospectively examined 156 patients' charts, 120 transgender women and 36 transgender men, from the Transgender Center at BMC. Thirty-five charts were excluded, as they did not contain smoking data (29 transgender women and 6 transgender men). Results: Twenty-eight transgender women (31%) were current smokers when they began treatment. Of those, 64% quit smoking over the course of initiating treatment. Of the 30 transgender men included in this study, 8 (27%) were current smokers when they began treatment. Of those, 25% quit smoking over the course of initiating treatment. Conclusion: Although others report that discussing tobacco use with a healthcare provider can increase rates of smoking cessation as seen with transgender men at our center, the substantially increased rate of smoking cessation among our transgender women suggests that greater impact can be achieved when a life-changing event is leveraged. Further, while some physicians raise concern over morbidity from hormone therapy, in our experience, good health habits initiated with care in our system more than outweigh the modest risks currently described.