Reid Vanderburgh MA, LMFT

Need another reason to quit?

Everyone knows the usual reasons for not smoking. “It’s bad for your breathing.” “You’re much more likely to get cancer.” “You stink.”

But if you are a transwoman taking oral versions of estrogen (pills as opposed to the injectible variety), there is another reason as well. You will probably find you have very little physical response to the estrogen (breast growth, rounder hips, etc.) if you smoke. One doctor, who sees many trans patients, commented, “In menopausal women nicotine increases the liver’s clearance of estrogen, therefore reducing the effectiveness of HRT. The same applies to transwomen. This only applies to oral estrogen which I try to avoid as a general rule.”

In addition to the addictive qualities of nicotine, people also smoke in stressful situations; nicotine helps reduce stress by dampening down emotionality to a degree. Imagine: you have just started taking estrogen and blocking testosterone, and you now have greater access to emotionality than you did while in a testosterone-based body. NOW, you add quitting smoking to the mix! This is not to say, keep smoking, just know that you might feel even more emotional without the nicotine in your system.

And one more reason — a U.S. surgeon whose practice is about 85% trans-related procedures said to me once, “I flat out won’t perform surgery on anyone who has smoked in the last 30 days. I find the complication rate and post-surgical scarring is much more problematic. I want folks to have a good result, and smoking interferes with that in a big way.”

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