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Smoking is sometimes used as a mechanism to cope with the pain of dysphoria or the stress of transitioning.

Smoking has been identified as a factor contributing to decreased semen quality in trans women, which can further impact fertility. Coping and Social Context smoken how shemales

Some trans women may feel pressured to act in specific ways, and smoking can sometimes be a part of those social, sometimes high-stress, environments. Smoking is sometimes used as a mechanism to