Tobacco use can increase the risk of several health conditions including issues with the heart, lungs, and certain types of cancer. It also increases the risk of blood clots especially when combined with estrogen. Smoking cigarettes can also cause erythrocytosis - too many red blood cells -  which can make blood “sludgy” and more prone to clot.  Because testosterone therapy already raises the number of red blood cells, smoking makes this worse for those taking T. 


We also know that the smoking rate in the transgender and gender expansive population is almost twice that of the cisgender population. Given the significant health benefits of tobacco cessation (quitting smoking) and the effectiveness of medications for tobacco cessation, we at Plume can help you kick the tobacco habit for good.


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What is nicotine dependence?

Nicotine dependence is the physical and psychological addiction to tobacco products. Nicotine is the addictive chemical inside tobacco.  It causes a short-term rush of endorphins in the brain, which cause a person to feel good.  This creates a reward circuit in the brain, and raises the levels of a chemical called dopamine. Dopamine reinforces the behavior of smoking, and more dopamine is needed over time. . When the person stops using tobacco, nicotine levels decrease in the brain and this can produce undesirable side effects. Signs and symptoms of nicotine withdrawal include irritability, restlessness, anxiety, insomnia, difficulty concentrating, and fatigue. It is common to experience cravings and urges to use tobacco again to relieve the side effects of low nicotine levels. 


How is nicotine dependence treated at Plume?

Our clinicians can use various medical approaches to treat tobacco dependence, such as nicotine replacement therapy, Bupropion SR (Wellbutrin SR), and Vareniciline (Chantix). Your Plume provider will evaluate your needs and determine the most appropriate treatment method during your appointment. In addition to receiving medication if deemed appropriate for you, patients can expect to develop a quitting plan with their Care provider and will receive additional educational resources to assist in their smoking cessation journey.  


Can I take hormones and consume nicotine products (cigarettes, vaping, etc)?

Patients on Testosterone

Most of the research on risk of heart disease and stroke in transgender men suggests that risk for these does not increase once testosterone is begun. However, longer term, definitive studies are lacking. We do know that testosterone raises cholesterol levels in trans male patients, and high cholesterol is a risk factor for heart disease and stroke.   It has been suggested that the risk of other conditions such as diabetes or being overweight is increased by masculinizing testosterone therapy, however actual research supporting these claims are limited.


Tobacco use also increases the risk of COPD, lung cancer, diabetes, macular degeneration (a type of blindness), and colorectal cancer). While tobacco use and vaping are not contraindications to testosterone therapy, your care team highly advises you consider quitting or significantly reducing your use..


Patients on Estrogen+

The risk of diseases like blood clots, heart attacks, and strokes as a result of estrogen hormone therapy is minimal, but may be elevated, especially for those with co-existing health conditions or starting hormone therapy after age 35. An increased risk of blood clots, strokes and heart attacks exists when taking estrogen combined with cigarette smoking.

Because age and family or personal history of these diseases can’t be changed, we highly recommend lowering your risk by addressing something that can - tobacco use and vaping.  For this reason, Plume highly recommends smoking cessation.  


As above, tobacco use also increases the risk of COPD, lung cancer, diabetes, macular degeneration (a type of blindness), and colorectal cancer.  Just several more reasons to cut back or quit!