Higher smoking rates in this demographic are often tied to "minority stress"—the chronic stress faced by members of stigmatized groups:
Smoking introduces specific risks for transgender women, particularly those undergoing gender-affirming medical treatments:
: Transgender women on estrogen-based hormone replacement therapy (HRT) face a substantially increased risk of cardiovascular issues, including heart disease, stroke, and life-threatening blood clots (thromboembolic events) when they smoke.