High prevalence of tobacco use among transwomen and transmen has been reported; however, little research has been conducted to investigate tobacco use among transwomen/men in relation to hormone use and psychosocial factors. Many transwomen and transmen seek to align their physical appearance to match their internal gender identity through taking cross-gender hormones and surgical procedures. During the transition, many transwomen/men face a number of difficulties due to transphobia, exposure to sexual and physical violence and harassment, and gender-based discrimination in employment, housing, and access to health care and social services. Professionally guided cross-gender hormone therapy and surgical interventions help transwomen/men to increase health and well-being and assist them to attain safety. However, access to professional hormone therapy and gender confirmation surgery is limited.
The reported widespread non-prescribed hormone use (NPHU) is troublesome because NPHU is associated with improper dosage and a lack of medical monitoring that elevates health risks. Due to transphobia and lack of access to transgender sensitive health care and social services, transwomen/men are experiencing high rate of negative health outcomes (e.g., substance use and mental health problems and high prevalence of HIV). Though research is limited, high prevalence of smoking among transwomen/men was reported. Further, transgender individuals may be especially vulnerable to the consequences of tobacco use, particularly as hormone use among smokers increases the risk of heart disease. Except for the prevalence of NPHU among transwomen/men, no studies have investigated the relationship between smoking and NPHU and prescribed hormone use (PHU) in psychosocial contexts.
We will first conduct qualitative interviews, and then a longitudinal survey recruiting adult transwomen/men in the San Francisco Bay area. We will test the hypotheses based on qualitative and quantitative methods: Hypothesis I: Transwomen/men who use non-prescribed hormones (NPHs) are more likely to smoke cigarettes than those who use only prescribed hormones (PHs); Hypothesis II: Transwomen/men who do not adhere to prescribed hormones (PHs) are more likely to smoke than those who adhere to prescribed hormones; Hypothesis III: Transwomen/men who have higher levels of transphobia and depression and lower levels of social support and self-esteem are more likely to smoke and use NPHs than their counterparts. Study findings will be disseminated through community forums and professional meetings and publications. Based on study findings, we will prepare a future tobacco prevention intervention study targeting high risk transwomen/men.