Associations Between the Length of Time from Transgender Identity Recognition to Hormone Initiation and Smoking Among Transgender Youth and Young Adults.

Gender-affirming medical interventions have been associated with mental health improvements among transgender individuals. However, little is known about optimal timing of these interventions as they relate to stress-sensitive behaviors such as smoking. We analyzed electronic health record data from transgender youth and young adults to examine whether longer duration from transgender identity recognition to hormone initiation was associated with smoking behaviors. Longer duration from age of identity recognition to age of cross-sex hormone initiation was associated with increased odds of current and lifetime smoking. Future research should investigate other potential risk factors associated with transgender-specific stressors for this population.