Association Between Sex Hormones and Mood, Cravings, and Urges in Males and Females Who Smoke Tobacco

Introduction: Mood influences smoking behavior, with sex and sex hormones potentially complicating these relationships. We explored associations between the profile of mood states (POMS) and Questionnaire on Smoking Urges (QSU) - Brief with sex hormones in men and women who smoke. Aims and Methods: This is a secondary analysis of treatment non-responders from a smoking cessation randomized trial investigating exogenous progesterone's efficacy. We considered the sex-specific associations between absolute serum progesterone (PRO) level and progesterone-to-estradiol ratio (P/E₂), as well as the relative change in serum PRO and P/E₂ with POMS and QSU subscale scores. Poisson generalized estimating equations models were used to estimate the associations. Results: The analysis included 127 participants (62 women: median age of 38, 61% White; 65 men: median age of 36, 54% White). There were sex-specific associations between POMS negative mood factors and relative PRO levels (eg, fatigue-inertia: women: 19% increase for a 10-fold increase in relative PRO, p=.03 vs. men: 10% decrease, p=.19) and relative P/E₂ (eg, lonely: women: 7% increase for a 10-fold increase in relative P/E₂, p=.63 vs. men: 27% decrease, p=.01). Generally, larger relative PRO and P/E₂ were associated with increased POMS negative mood factors in women, while larger relative PRO and P/E₂ in men were associated with decreased POMS negative mood factors. Similar trends between POMS negative mood factors and the absolute PRO and P/E₂ were observed. No significant associations were observed with POMS positive mood factors or QSU subscales. Conclusions: These findings suggest that the change in PRO and P/E₂ may influence negative mood factors differently in men and women who smoke. Additional research is needed to understand how these sex-specific associations may contribute to smoking cessation. Implications: Progesterone and estrogen were linked to increased negative mood factors in women, whereas in men they were linked to a decrease in negative mood factors. These observations shed light on potential sex-specific intervention targets for mood management in adults who smoke.