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Research indicates that transgender and gender-expansive (TGE) adults are significantly more likely to smoke than cisgender individuals.

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: Tobacco use can interfere with estrogen therapy. It is known to potentially lower the effectiveness of oral estrogen and significantly increase the risk of dangerous blood clots. hot shemale smoking

: Some individuals use smoking as a way to affirm gender identity—for instance, viewing it as a "masculine" or "rebellious" trait. Conversely, stressors like internalized transphobia and targeted advertising by the tobacco industry contribute to higher rates. hot shemale smoking