Tobacco use is the leading global cause of preventable disease and death, and transgender and gender-expansive (TGE) people demonstrate elevated tobacco use. Gender-affirming (GA) surgeries are growing in demand, thus understanding associations between GA surgeries and tobacco use is critical. The purpose of this systematic review was to review existing data on the associations of tobacco use with GA surgeries for TGE people. Articles explored surgical outcomes associated with smoking, and/or reported tobacco prevalence of their surgical sample.
Methods:
Searches were conducted through March 2023 in three databases and two search engines (PubMed, Embase, PsycINFO, Google Scholar, and MedNar, respectively) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Results:
Seventy-five articles met the inclusion criteria. Tobacco use was usually reported as “smoking” (52 studies, 69.3%), in nonspecific, wide-ranging language. Cigarettes and/or tobacco were specifically named in only 26 studies (34.7%). No studies named other tobacco/nicotine products such as e-cigarettes, despite their popularity. Just over half of the studies explored smoking’s role in postsurgical outcomes, where findings were mixed. Smoking cessation or abstinence was required in 16 (21.3%) studies, but only 2 (2.7%) offered quitting assistance.
Conclusion:
Ambiguity regarding “smoking” diminishes our ability to assess associations between tobacco use and GA surgeries. Uniform and consistent tobacco assessment is critical, particularly among a group that exhibits tobacco use disparities and may undergo GA surgeries. GA surgery may be a promising avenue for reducing TGE tobacco disparities. Medical teams should offer quitting assistance to TGE patients under their care.
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