: Many healthcare providers require patients to stop using nicotine—including smoking, vaping, and chewing tobacco—well before undergoing gender-affirming surgeries to ensure proper healing and reduce surgical risks. Factors Influencing Smoking Rates

Conversely, positive steps toward transition can have a protective effect. For example, a change in legal gender markers or undergoing desired surgeries is associated with lower odds of tobacco use. Specialized support programs are available through organizations like the Center for Addiction and Mental Health to help TGD individuals face substance use challenges in a safe environment. Gender-Affirming Hormone Therapy (GAHT)

: High rates of smoking are consistently linked to victimization and felt stigma.

: Minority stress, combined with tobacco use, can lead to arterial stiffening and endothelial dysfunction, elevating the risk of cardiovascular disease.

: Transgender adolescents are more likely than their cisgender peers to have used cigarettes or vaped in the past 30 days.