Limited Evidence for Sex Differences in How Cannabis Acutely Affects Thinking | Research

The takeaway

A systematic review of 29 studies found only 6 reported sex differences in the acute cognitive effects of cannabis, with women showing slightly greater impairment when differences were found, but the overall evidence was too inconsistent for firm conclusions.

Cannabis researchers and anyone interested in whether cannabis affects men and women differently.

Only 3.7% of cognitive outcomes showed sex differences

What the researchers found

Of 29 studies meeting criteria, only 6 (20.7%) found statistical evidence of sex differences in acute cognitive effects, representing just 8 of 216 cognitive outcomes tested (3.7%). All 6 found increased effects in females on at least one measure. No clear patterns emerged by dosing method, route of administration, or cognitive domain.

Why it matters

Cannabis policy and clinical guidance are largely sex-neutral, but biological sex differences in cannabinoid metabolism and receptor density could mean men and women experience different cognitive effects. This review finds that the current evidence is insufficient to confirm or deny this possibility.

The numbers in context

29 studies included from 1,625 screened. 216 total cognitive outcomes examined. 8 outcomes (3.7%) showed sex differences. 6 of 29 studies (20.7%) found any sex difference. All significant findings showed greater effects in females.

How the study worked

Systematic review following PRISMA guidelines searching Embase, MEDLINE, PsycInfo, Cochrane, and Web of Science. Of 1,625 unique records, 169 underwent full-text screening, and 29 studies met inclusion criteria. Studies had to examine acute cannabis or THC effects on cognition with sex-disaggregated results.

What this study cannot tell us

Most included studies were not designed to detect sex differences and may have been underpowered. Methodological heterogeneity across studies (different doses, routes, cognitive tests) limits comparison. Hormonal factors were rarely measured.

How to read the evidence

Comprehensive systematic review following PRISMA guidelines. The finding of limited evidence reflects the state of the research rather than proving no differences exist.

When this study was published

Published in 2025.

The bigger picture

The lack of evidence for sex differences may reflect genuine similarity or simply inadequate research. Most cannabis studies have been conducted predominantly in male participants, and few were designed to detect sex differences. The consistent direction (females more impaired when differences appear) warrants targeted investigation.

Questions still open

Would well-powered studies designed specifically to detect sex differences find stronger effects? Do menstrual cycle phase or hormonal contraceptive use influence acute cognitive effects of cannabis?

Common questions

Does cannabis affect women more than men?

The evidence is unclear. When sex differences were found (in only 6 of 29 studies), women tended to show greater cognitive impairment. But the vast majority of outcomes showed no difference, and most studies were not designed to detect sex effects.

Why might there be sex differences in cannabis effects?

Potential mechanisms include differences in body fat distribution (THC is fat-soluble), hormonal influences on cannabinoid receptor sensitivity, and sex differences in liver enzyme activity that metabolizes THC.

Read the original research

Sex differences in the acute effects of cannabis on human cognition: A systematic review.

Frontiers in neuroendocrinology, 79, 101215

View on PubMed ↗Publisher’s paper ↗

Citation

Matheson, Justin; Behzad, Danial; Zakala, Christina; Hawken, Thomas; Brands, Bruna; Le Foll, Bernard; Wickens, Christine M; Ruocco, Anthony C; Rodak, Terri; Di Ciano, Patricia. (2025). Sex differences in the acute effects of cannabis on human cognition: A systematic review.. Frontiers in neuroendocrinology, 79, 101215. https://doi.org/10.1016/j.yfrne.2025.101215