Heavy cannabis use linked to higher risk of erectile dysfunction and low testosterone

Cannabis abuse/dependence was associated with a 3.99-fold increased risk of erectile dysfunction and 2.19-fold increased risk of testosterone deficiency within one year, based on a propensity-matched analysis of nearly 30,000 men per group.

Researchers used TriNetX, a large US claims database, to identify men 18 and older with cannabis abuse/dependence diagnoses between 2005 and 2024. They propensity-matched 29,442 cannabis-diagnosed patients against an equal control group on 49 factors and compared risks at short-term (3 months to 1 year) and long-term (3 to 5 years) intervals.

Erectile dysfunction and low testosterone are common concerns for men, yet the relationship between cannabis and male sexual health has been studied only in small samples with mixed results. This population-level analysis provides some of the largest-scale evidence to date linking heavy cannabis use to these outcomes.

The absolute risk differences are small, but the relative risk ratios are striking, especially in the short term. The finding that the association with testosterone deficiency faded over longer follow-up raises questions about whether the relationship is driven by acute hormonal effects or confounding by other substance use patterns.

Claims database diagnoses of cannabis abuse/dependence are proxies that may miss casual users and overrepresent severe cases. The study could not assess dose-dependent relationships or control for method of cannabis consumption. Residual confounding from unmeasured factors remains possible despite propensity matching.