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Emergency Medicine News

The Case for Cannabis

Cannabis, Testosterone, and Gender Inequality

Yafai, Sherry MD

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doi: 10.1097/01.EEM.0000734856.67231.72
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    Some men worry that they are not manly enough, and wonder if a lack of testosterone is the reason. Others comment, like a reader recently did, on the age-old fearmongering, unscientific propaganda about Cannabis (specifically THC) that it is a “potent suppressor of testosterone.” (“Using Cannabis for Self-Care,” EMN. 2020;42[9B]; https://bit.ly/3nt80s3.)

    Recent research on the recreational use of Cannabis, inferred as THC, showed that it results in an increase in testosterone, albeit temporarily. One study by a group of male urologists (World J Urol. 2020;38[12]:3275) reproduced the findings of another study by the National Institutes of Health that found THC use is associated with an increase in testosterone. (Andrology. 2017;5[4]:732; https://bit.ly/2MGmmsi.) Another paper said “a dose-response relationship between increasing serum testosterone and decreasing time since last regular use indicating that recency of use, not duration or frequency of use, had the strongest relationship with testosterone levels.” (Andrology. 2017;5[4]:732; https://bit.ly/2MGmmsi.) That means the more recently a man has smoked THC, the higher his testosterone level is.

    Another study from Stanford University's department of urology showed that THC use is “independently associated with increased sexual frequency and does not appear to impair sexual function.” (J Sex Med. 2017;14[11]:1342.) Interesting.

    So men are likely to see an increase in testosterone levels and an increase in sexual frequency when smoking THC. Why is this important to me, a female physician?

    Simple: It is not going to work to use scare tactics to create fear among adolescent and young male patients, friends, and family who are using or considering smoking Cannabis. Lecturing the young male generation will only identify you as being out of touch with the latest research. It will result in a lot of eye-rolling and a lack of confidence in you as a clinician. If you think any young person will listen to his doctor blindly without googling, think again. Marijuana fan pages are plentiful, and it takes just one search on Google to find articles like “Cannabis Consumers Have Higher Sperm Counts, Harvard Study Finds” via Leafly's website, which shares information about Cannabis. (Feb. 7, 2019; https://bit.ly/3ov2C9d.)

    Now this young adult has a website with a title convincing him that there are no harms to using Cannabis as it relates to testosterone and sex. This will happen even though the research is inconclusive (these studies were not perfect). We should all push for better research in this field.

    The Right Approach

    A more astute clinician would approach a patient with excessive Cannabis use by looking to understand the actual underlying disorder that has led to that abuse such as general or COVID-related anxiety, lack of self-confidence, fear, and trauma. Young men tend to misuse and abuse Cannabis (and other drugs and alcohol), but are not often asked deeper questions, especially not in the ED. The traditional paternalistic method of “do what I tell you” or “do what I tell you because I am telling you scary things” is fast and easy, but not a good way to engage or treat patients.

    Let me be clear, I do not advise patients to use this medication because it is “rad” (in the words of a Cannabis addict patient of mine), but I do counsel them on how to avoid toxic dosages (i.e., wax, dab, and shatter, all of which are 90% THC concentrates and above compared with flower, which maxes out at a high 20% THC), and find out what the underlying diagnosis is to encourage therapy, better family dynamics, and redirection toward medical evaluation that may benefit them in the long term. Counseling patients on how to replace and remove opioids and benzodiazepines, which are often ineffective and horrifically addicting, and use low-dose CBD or THC and other cannabinoid combinations instead can also prove to be a more effective treatment for those with anxiety, migraines, and pain, to name a few.

    The obsession of research and the scientific fields with all things sexually male is excessive, highlighted by the commenter who sparked this column and by the Nobel Prize in Medicine being awarded to the scientists who paved the way for the discovery of Viagra in 1998. It took 17 years after that for the first female sexual medication to come around. The shocking part is that readers probably don't even know that one exists (I didn't). It's called Addyi, and is a little pink pill (good for a game of trivia).

    Why is this important in a discussion about Cannabis? Female orgasm and sexuality in relation to THC use are now being evaluated by a group at Stanford's department of urology this year. And guess what? “Increased frequency of marijuana use is associated with improved sexual function among female users.” (Sex Med. 2020;8[4]:699; https://bit.ly/3s9pZr5.) THC use among women resulted in an increase in desire, arousal, orgasm, and completion! As a first study in this realm, this shows some promising results.

    Common-Sense Standard

    Let me conclude by saying what I previously thought was obvious. Don't drive while intoxicated by any chemical, medication, or drug, including alcohol, opioids, benzodiazepines, and Cannabis or THC products. Don't go to work, regardless of your profession, while intoxicated. Nightly use of any substance, including alcohol, opioids, benzodiazepines, and Cannabis or THC products may be the result of a mental or physical health issue for which you may need counseling. The use of any and all of these pills, drinks, drugs, and medications should be done within basic legal and common-sense standards. If you find that your memory is failing you at work because you drank, smoked, abused your drug of choice prior to work or on a daily basis, this constitutes a real problem for which you need help.

    This column is not meant to provide any medical advice for or against the use of Cannabis in this type of setting, but to present an equal platform for and against multiple drugs, pills, medications, etc., that are used commonly for anxiety, stress, insomnia, pain, or erectile dysfunction.

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