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

The takeaway

Men diagnosed with cannabis abuse or dependence had nearly four times the risk of erectile dysfunction and double the risk of testosterone deficiency in the short term.

Men who use cannabis regularly and are concerned about sexual health or hormonal changes.

3.99x higher risk of erectile dysfunction within one year among men with cannabis abuse/dependence diagnoses

What the researchers found

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.

Why it matters

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 numbers in context

At 3 months to 1 year: ED risk 0.9% vs 0.2% (RR 3.99), TD risk 0.2% vs 0.1% (RR 2.19), PDE5 inhibitor prescriptions 0.8% vs 0.2% (RR 3.80). At 3 to 5 years, only ED remained significant (1.61% vs 1.34%, RR 1.20). Kaplan-Meier analysis showed faster time to ED (HR 1.65) and TD (HR 1.34).

How the study worked

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.

What this study cannot tell us

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.

How to read the evidence

Large, propensity-matched retrospective cohort using a national claims database, though limited by diagnosis code proxies and inability to assess dose-response.

When this study was published

Published in 2025, using claims data from 2005 to 2024.

The bigger picture

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.

Questions still open

Does the dose or frequency of cannabis use matter for these outcomes? Would occasional users show similar patterns? Are the short-term associations driven by acute hormonal disruption or by lifestyle factors common among people with cannabis use disorder diagnoses?

Common questions

Does this mean cannabis causes erectile dysfunction?

The study found an association, not causation. Men diagnosed with cannabis abuse or dependence had higher rates of ED, but claims data cannot establish whether cannabis directly caused it or whether shared risk factors explain the link.

Were casual cannabis users included?

No. The study only captured men with formal diagnoses of cannabis abuse or dependence, which represents heavier or more problematic use patterns rather than occasional consumption.

Did the testosterone effects persist long-term?

The association with testosterone deficiency was significant at 3 months to 1 year but did not reach significance at the 3 to 5 year mark, suggesting any hormonal effect may be more acute.

Read the original research

Association of cannabis abuse/dependence on risks of erectile dysfunction and testosterone deficiency using a large claims database analysis.

The journal of sexual medicine, 22(5), 711-718

View on PubMed ↗Publisher’s paper ↗

Citation

Davis, Ryan; Hershenhouse, Jacob; Maas, Marissa; Loh-Doyle, Jeffrey; Asanad, Kian. (2025). Association of cannabis abuse/dependence on risks of erectile dysfunction and testosterone deficiency using a large claims database analysis.. The journal of sexual medicine, 22(5), 711-718. https://doi.org/10.1093/jsxmed/qdaf043