The Hidden Hormonal Risks of E-Cig

Electronic cigarettes (e-cigs) are battery-operated devices that aerosolize liquids for inhalation. Commonly known as vapes, e-cigs were invented in 1965. Their use has increased since 2007 and is more popular among younger individuals and men.

How Vaping Affects Hormonal Health

E-cig use has been associated with a range of endocrine-related effects, including:

• Prediabetes
• Type 2 diabetes mellitus
• Obesity

It may also impact reproductive health, with studies suggesting:

• Reduced fertility (fecundability)
• Lower sperm count

Additionally, vaping may worsen Graves’ eye disease.

What Are Inside E-Cigarettes

E-cig liquids typically contain nicotine and flavouring agents. However, it is becoming increasingly common to find psychoactive substances in these liquids, including:

• Cannabinoids
• Cocaine
• Benzodiazepines
• Ketamine
• Etomidate

The presence of these substances particularly etomidate raises significant health concerns.

Etomidate and Its Effects on the Body

Etomidate is a general anaesthetic agent that was introduced in clinical practice in 1972. It is known to suppress adrenal function by inhibiting key enzymes involved in steroid hormone production.

This disruption leads to:

• Reduced production of the hormones cortisol and aldosterone
• Excessive production of the hormones androgen and deoxycorticosterone

Understanding Adrenal Insufficiency

Adrenal insufficiency occurs when the adrenal glands do not produce enough hormones, particularly cortisol.

In cases linked to etomidate exposure through vaping, patients may experience:

• Low cortisol levels (glucocorticoid deficiency)
• High androgen levels – which may cause irregular periods and excessive facial hair growth in women
• High deoxycorticosterone levels – may lead to high blood pressure and low potassium levels, causing weakness and cramps

In some cases, this may mimic congenital adrenal hyperplasia (CAH).

How Adrenal Suppression Presents

Since 2024, multiple cases of adrenal suppression linked to vaping etomidate have been reported.

Common Patterns

• Most patients had low cortisol levels
• Some developed:
  • High blood pressure
  • Low blood potassium levels (hypokalaemia)
  • High blood androgen levels 

However, presentations vary widely depending on: 

• Dosage of etomidate in the e-cig 
• Duration and frequency of e-cig use 
• Presence of other contaminants in the e-cig liquids

Why This Matters

Adrenal suppression from inhaled substances such as etomidate can be unpredictable and serious.

Unlike short-term medical use, repeated exposure through vaping may lead to prolonged hormonal disruption, with recovery taking months.

When to Seek Medical Advice

Seek Medical attention if you experience: 

• Persistent fatigue
• Dizziness or fainting
• Low blood pressure
• Unexplained hormonal symptoms

Early diagnosis and treatment are important to prevent complications.

If you notice persistent or unusual symptoms, consider seeking a medical assessment.

At Nobel Endocrinology & Diabetology, we support patients from identifying hormonal imbalances to managing established endocrine conditions. Early review can provide clarity, reassurance, and timely support for your recovery.

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