Limited Evidence for Sex Differences in How Cannabis Acutely Affects Thinking

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.

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.

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 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.

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.