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For transgender youths, delay in cross-sex HT initiation increases risk for smoking
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Among transgender adolescents, a longer delay between the recognition of transgender identity and the initiation of cross-sex hormone therapy is independently associated with an increased risk for current and lifetime smoking, according to findings published in Transgender Health.
Transgender identity development may present a period in which transgender-specific minority stressors place transgender adolescents at increased risk for developing maladaptive coping behaviors, such as smoking, Sari L. Reisner, ScD, associate scientific researcher and assistant professor of pediatrics at Harvard Medical School, and colleagues wrote in the study background.
“Transgender individuals may be at higher risk of developing smoking behaviors earlier than their cisgender peers,” Reisner and colleagues wrote. “Of note, a previous study reports 14.3 years as the average age of smoking initiation in a sample of daily smokers (n = 167) who identify as transgender adult women; this is younger than the average age reported for cisgender men (15.6 years) and cisgender women (16.7 years) in a nationally representative sample (n = 16,985).”
In a retrospective, cross-sectional analysis, the researchers assessed electronic health records extracted in 2014 from 46 transgender patients seen between 2002 and 2011 at an urban, community-based health clinic in Boston (mean age, 19 years; 76% white). Included patients reported both their age of transgender identity recognition and age of ever having initiated cross-sex HT. Researchers created a time difference variable by subtracting the reported age of transgender identity recognition from the reported age of hormone initiation and used multivariable logistic regression models to assess whether the time difference variable was independently associated with an increase in the odds of current and lifetime cigarette smoking.
Within the cohort, 63% identified as transgender boys or men. The average age of transgender identity recognition was 12.13 years and the average age of cross-sex hormone initiation was 19.76 years. The average time difference between the two variables was 7.63 years.
Overall, approximately 22% of included transgender youths and young adults reported current smoking and 30% had ever smoked, according to researchers.
The researchers found that transgender adolescents with a longer duration between the age of transgender identity recognition and the age of cross-sex HT initiation had 23% increased odds of current cigarette smoking (95% CI, 1.03-1.48) and 31% increased odds of lifetime cigarette smoking (95% CI, 1.08-1.59). Results persisted after adjusting for psychiatric morbidity and other sources of gender affirmation.
The researchers noted that the study did not include measures of whether and how long patients were administered pubertal blockers before cross-sex hormone initiation.
“However, our preliminary findings, along with documented improvements in mental health, reported reductions in harassment and improved quality of life in transgender individuals after gender-affirming medical intervention, suggest that earlier timing of cross-sex hormone initiation after gender recognition, while also considering appropriate pubertal timing, may have protective effects for preventing smoking behaviors among transgender adolescents,” the researchers wrote. – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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