How Cannabis Affects Men and Women Differently: A Scoping Review

This scoping review synthesized evidence on sex-specific behavioral responses to cannabis. The literature reveals that sex differences exist in cannabis sensitivity, tolerance development, withdrawal severity, and various behavioral outcomes. These differences appear to be mediated by hormonal influences on the endocannabinoid system, particularly estrogen's effects on CB1 receptor expression and endocannabinoid tone.

Scoping review focused on tetrahydrocannabinol (THC) as the principal psychoactive constituent. Examined preclinical and clinical literature on sex differences in cannabis use patterns, behavioral effects, and endocannabinoid system function.

As cannabis legalization expands, understanding sex-specific effects becomes increasingly important for both public health messaging and clinical applications. Much of what we know about cannabis effects comes from male-dominated research, potentially missing important differences in how women respond.

The push to include sex as a biological variable in research (mandated by NIH since 2016) is slowly changing the cannabis research landscape. This review highlights just how much remains unknown about sex-specific responses and underscores the importance of designing future studies that can detect these differences.

Scoping review provides breadth but not the statistical rigor of a systematic review. Predominantly focused on THC, with less coverage of CBD and other cannabinoids. Much of the mechanistic evidence comes from animal studies. Clinical data on sex differences remain limited.