Vaping, Nicotine Pouches and Testosterone: What Nicotine Really Does to Men

He gave up cigarettes three years ago and switched to a vape. Then, at the gym, a friend handed him a tin of nicotine pouches, and now he has one under his lip most of the day: on the commute, at his desk, before training. He is 29, fit, and convinced that because he no longer smokes, nicotine is doing him no harm.

Recently he read online that nicotine "kills testosterone". Another forum claimed it raises it. Both cannot be true.

The honest answer is more interesting than either. Nicotine does not appear to lower testosterone in the blood, and smokers often have slightly higher levels than non-smokers. But testosterone is not the whole story of male health. The evidence on erections and sperm is far less reassuring, and those are the things most men actually care about.

What we know about smoking and testosterone

Start with cigarettes, because that is where most of the research is. A 2016 systematic review and meta-analysis by Zhao and colleagues pooled 22 studies involving more than 13,000 men. Smokers had, on average, testosterone about 1.5 nmol/L higher than non-smokers.

That surprises people, but it fits other evidence. Nicotine and its breakdown product cotinine may interfere with the enzymes that clear testosterone, and smoking can raise SHBG, the protein that carries testosterone in the blood, which pushes total testosterone up. Whatever the mechanism, there is no good evidence in humans that smoking or nicotine causes low testosterone in the blood.

That does not make smoking good for hormones. It simply means testosterone is the wrong measure of the damage.

What about the animal studies?

Many articles online cite experiments in which rats given nicotine had damaged Leydig cells, the cells in the testes that make testosterone, and lower testosterone. These studies exist, but they often use high doses delivered in ways that do not match human use. They are a reason for caution, not proof of what happens to a man using a vape or pouches.

Erections: where nicotine does real harm

An erection depends on blood flowing quickly into the penis, which depends on healthy blood vessels and a chemical called nitric oxide. Nicotine works against both. It narrows blood vessels, raises heart rate and blood pressure in the short term, and over time contributes to damage to the lining of the arteries.

That is why smoking is a well-established cause of erectile dysfunction. The newer question is whether vaping carries the same risk.

A 2022 study by Omar El Shahawy and colleagues at NYU analysed data from the US PATH study, a large national survey of tobacco use. Among 13,711 men aged 20 and over, daily e-cigarette users were 2.24 times more likely to report erectile dysfunction than men who had never vaped. When the researchers limited the analysis to 11,207 men aged 20 to 65 with no history of heart disease, the figure was 2.41.

This was a survey, so it shows an association rather than proof that vaping caused the problem. Many vapers are former smokers, which makes it hard to separate the two. But the direction matches what we know about nicotine and blood vessels.

Erectile problems can also be an early warning of heart disease, because the arteries in the penis are smaller than those in the heart and show damage earlier. We cover the wider picture in can low testosterone cause erectile dysfunction?

Sperm: the warning from Denmark

The other concern is fertility. A 2020 study by Stine Holmboe and colleagues at Copenhagen's Rigshospitalet examined about 2,000 young Danish men recruited at their compulsory military fitness examination, of whom around 1,200 were asked about e-cigarettes.

Men who used e-cigarettes every day had lower total sperm counts than men who did not use nicotine at all, a pattern similar to that seen in daily cigarette smokers. Their testosterone and other reproductive hormones did not differ by e-cigarette use. As with the erection study, this was a snapshot rather than a trial, and only a small number of men were daily vapers, so the findings need confirming.

But the result fits laboratory work showing that e-cigarette liquids and vapour can affect sperm, and the wider evidence that smoking harms sperm count, movement and DNA. If you and your partner are trying for a baby, nicotine in any form is worth cutting out. See sperm count: what lowers it, what raises it.

Nicotine pouches: the newest habit

Nicotine pouches are small white sachets placed between the lip and gum. Unlike snus, the Swedish product they resemble, they contain no tobacco leaf, mainly nicotine, plant-based fibre, flavourings and other additives. They have become popular with gym-goers and footballers, partly because they are discreet and partly because they are marketed as a "clean" form of nicotine.

There is very little research on pouches and male hormones specifically. What we can say is:

• The nicotine is the same. Its effects on blood vessels, heart rate and blood pressure are broadly similar however it is delivered.
• Strengths vary widely. Some pouches contain far more nicotine than a typical cigarette delivers, which makes dependence easier, not harder.
• Constant use means constant exposure. A pouch in all day keeps nicotine levels topped up in a way occasional smoking does not.

There is little research on snus and testosterone, but Swedish studies link snus to a higher risk of high blood pressure and lower sperm counts, so it is not a clean bill of health.

Does nicotine help or harm training?

Some lifters use nicotine before training for focus and a lift in energy. Nicotine is a stimulant and does sharpen alertness for a short time. But it also raises heart rate, narrows blood vessels, and can worsen sleep if used later in the day. Poor sleep is a far more reliable way to lose testosterone than nicotine itself. See does sleep affect testosterone?

If you rely on a pouch or a vape to get through every session, that is dependence, not a performance aid.

Vaping versus smoking: keep it in perspective

None of this means a smoker should avoid vaping. The NHS is clear that vaping poses a small fraction of the risk of smoking, and switching completely from cigarettes to a vape is one of the most effective ways to quit. Vapes and pouches do not produce tar or carbon monoxide, two of the most harmful parts of tobacco smoke.

The point is that vaping and pouches are a step down, not a finish line. For a man thinking about his erections, his fertility or his heart, the best position is no nicotine at all.

The rules are tightening too. Single-use vapes have been banned from sale across the UK since June 2025. The Tobacco and Vapes Act 2026, which became law in April 2026, bans advertising and sponsorship of vapes and nicotine products, and from 29 October 2026 it is illegal to sell nicotine pouches or vapes to anyone under 18.

How to cut down

• Step down the strength gradually, whether you vape or use pouches, rather than stopping cold overnight if you are heavily dependent.
• Break the routine links: the first pouch of the morning, the one before training, the vape with coffee.
• Use support. Nicotine replacement therapy can ease cravings, and many local NHS stop smoking services, which are free, will also help people stop vaping or using pouches.
• Expect a few rough weeks. Irritability, poor concentration and cravings usually ease within a month.

The bottom line

Nicotine is not the testosterone killer it is often made out to be; if anything, smokers tend to have slightly higher levels. But that is the least important part of the story. Nicotine harms blood vessels, and daily vaping is linked to more erectile dysfunction and lower sperm counts. If you smoke, switching to a vape is a big improvement. If you already vape or use pouches, the next win is getting off nicotine entirely.

Common questions

Does vaping lower testosterone?

There is no good evidence that it lowers testosterone in the blood. Studies of smokers find slightly higher testosterone on average. The bigger concerns with vaping are erectile function and sperm count.

Can vaping cause erectile dysfunction?

It is linked to it. In a US survey of more than 13,000 men, daily e-cigarette users were more than twice as likely to report erectile dysfunction as men who had never vaped. Nicotine narrows blood vessels, which is the likely reason.

Do nicotine pouches affect testosterone?

There is little research on pouches specifically. The nicotine they contain has the same effects on blood vessels as other forms, and there is no evidence they raise testosterone or improve sexual health.

Does vaping affect fertility?

A Danish study of about 2,000 young men found lower sperm counts in daily e-cigarette users. If you are trying for a baby, it is sensible to stop all nicotine.

Is vaping better than smoking for men's health?

Yes. Vaping is far less harmful than smoking and is an effective way to quit. But stopping nicotine altogether is better still for your heart, erections and fertility.

Sources: Zhao J et al., Cigarette smoking and testosterone in men and women: a systematic review and meta-analysis of observational studies, Prev Med 2016;85:1-10 · El Shahawy O et al., Association of e-cigarettes with erectile dysfunction: the Population Assessment of Tobacco and Health study, Am J Prev Med 2022;62(1):26-38 · Holmboe SA et al., Use of e-cigarettes associated with lower sperm counts in a cross-sectional study of young men from the general population, Hum Reprod 2020;35(7):1693-701 · NHS, Using e-cigarettes to stop smoking · Educational only, not medical advice.

Keep reading: Can low testosterone cause erectile dysfunction? · Sperm count: what lowers it · Does cannabis lower testosterone? · The truth about alcohol and testosterone · Morning erections and testosterone · Is TRT safe for your heart?