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: The use of estrogens in transgender women already carries an increased risk of myocardial infarction and ischemic stroke. Smoking significantly exacerbates these risks, as it introduces oxidants and free radicals that cause oxidative stress and systemic inflammation.

Smoking introduces specific complications for transgender women, especially those undergoing hormone replacement therapy (HRT): hot shemale smokers

: Some trans women observe that smoking styles can differ by gender, with women often using smoking as a way to manage stress. : The use of estrogens in transgender women