For the most part, my approach to prescribing hormones is “sure,” but I will note that the one thing I lean HARD on patients about is smoking. If you’re transgender, and you’re on hormones, the number one thing we want to protect is your cardiovascular health. That’s frankly the number one thing I want to protect in all my patients, but anyone taking exogenous hormones is at higher baseline risk. And the best thing you can do for your heart is DON’T SMOKE. It’s a bitch to quit, and I didn’t even smoke much or long before I quit in my late teens, and I STILL didn’t enjoy quitting and had smoking dreams for years. It’s harder to quit than just about anything else up to and including crack and heroin, and that’s coming from a patient of mine who recently passed in her early 60s who’d done all of those things—for years and years—but eventually was able to quit everything except smoking. And that killed her. She developed severe COPD and eventually called to say her blood oxygen saturation was dipping into the 70s, which is incompatible with life. She was lucid enough to decline medical care, including refusing to call 911 or go to the ER. A week later, after both I and one of our outreach nurses had contacted her to ask her to please go to the ER, I got a notification that she’d been found dead. She had been so frustrated that she wasn’t a candidate for a lung transplant.
One of my oldest trans patients is in her late 50s. She’s had blood clots that went to the lungs. Repeatedly. Smoking raises that risk. Estrogen raises that risk. She’s a veteran with PTSD; of course she smoked.
These aren’t theoretical. These are humans I’ve cared for over years of their lives. I have been rooting for them—my beloved former addict, who spoke without shame about her years of homelessness and drug use in the city; my queer elders, who are slowly trading in their motorcycles for power scooters. I want everyone to live their fullest, best life.
Smoking doesn’t fit into that. Please don’t smoke. I don’t want you to die like that—not now and not later. I want you to have the future that you may not be able to see yet, but exists.
Since I moved home as an out queer, word got out, and there’s a whole apartment complex of lesbians in their 60s to their 80s who come see me—sitting next to their wives in the office, nagging about blood pressure meds, tattling about not having gotten the shingles shot they said they would. To be clear, when I was growing up in town, I knew no lesbians. Not one. I knew one gay kid in my class, which eventually turned into two. We were it. To see these women living decades with their wives and being able to squabble like any couple in my office over who was supposed to bring their home blood pressure cuff in for us to check it… it means the world to me.
In addition to the fact that it kills you and the people around you, you should quit because Big Tobacco are smug, queer-hating assholes who named their campaign to hook gays “Operation SCUM” and, cross my heart, I am not shitting you. They also made the playbook used by Big Oil and antivaxx conspiracy theorists.
So, just a reminder that spite is a great reason to quit smoking.
Also, I keep hearing people RAVE about the book The Easy Way to Quit Smoking by Allen Carr. You can do this - other people have done this! There’s help out there. And spite.
Good addition! Quit smoking to stand against capitalism!
HI harm reduction for anyone who just picked up the habit and feel very black and white about everything! Or anyone feeling too black and white and going well I guess I'll die then who cares! Harm reduction here
- smoke less! Make arbitrary rules about when you get to smoke. Tie smoking to some thing you hate to do but need to get done. Like, I only get to smoke when I do (thing I gotta do). Or I only get to smoke... when I am dressed for the day and have left the house. Whatever works from where you're starting. No smoking indoors, whatever, only 1 cigarette after work, make shit up
- If you're doing the "i only smoke when I drink" or "I only smoke socially" and it's becoming hanging out w smokers more often or drinking more often -> switch it up w prior thing new rules. I only smoke... alone. I don't smoke... with coffee. Whatever. Smoking w other smokers IMO only leads to more smoking don't do that for either of you
- Get your space smelling less of cigarettes. Like, wash your clothes all of em, designate one item your smoking jacket or whatever. Basically work to overcome the olfactory fatigue so you can actually smell how much you stink. I swear this one works even if you currently feel that you like the smell
- if you JUST STARTED, but your mental health is so shit that you don't have it in you not to smoke, moderate as well as you can to stave off the actual addiction part. Like, switch to lower nicotine cigarette brands (lights don't mean less, google this one). Don't smoke every day. Go every other. Make that your hard line - not every day. Give future you a better chance at kicking it
- In any context of this any starting point, supporting yourself through other avenues will help. Quality sleep, nutrition, exercise, mental health care, whatever all the basics anything achievable for you do those things if you can
- Substitute treats. Pick other things to treat yourself. Food, tv, bed rot, whatever. Let your id have other stuff that's not smoking
Ok im done this is all just. Idk stuff I wish I'd known decades ago that I hope can help others. There can be more to it than just quitting or not quitting if you feel stuck or hopeless in it cheers on the nebulous other
It’s also worth noting that people get discouraged by repeated attempts to quit, but the people who succeed at quitting and making it stick? Are people who have on average tried many, many times! Don’t beat yourself up if you struggle. The struggle is not weakness, it’s where the success comes from.
