% Smoking
Smoking already increases risk of blood clots (as well as other issues). For trans women, it's worse because oral estrogen increases risk of blood clots. Nicotine (from cigarettes, e-cigs, vaping, patches, etc) interferes with how oral estrogen is metabolised, to the point where you might as well not use it orally. Our self-medication guide also describes this.
Whether trans woman, trans man, non-binary, cis or other, smoking is bad for both your mental and physical health. It causes cancer, stroke, heart attack, heart disease, impotence, and lots of other things. It also messes with dopamine and serotonin and can cause some depression symptoms.
If you won't quit using nicotine, we recommend using e-cigs (vaping). The risks aren't well-known, but generally it's believed to be safer than smoking.
Smoking also complicates surgery, again due to clotting risk. Vaping (e-cigarettes) is considered safe.
Using patches long-term probably isn't good for most smokers. It doesn't really give you that same fix as a cigarette or e-cig really, so it's no wonder why smokers switch to e-cigs these days.
Quitting nicotine cold-turkey is the most logical thing to do.
This cold-turkey quitting site is very good for those who want to know how to quit successfully.
You'll notice physical and mental improvements after quitting nicotine usage, especially if it's cigarettes that you're quitting.