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Medical Cannabis, Hormones, and Metabolism: What We Know (And Don’t Know)

Total Studies on Topic

Thyroid Cancer

# of studies = 12

# of positive results = 9

# of inconclusive results = 0

# of negative results = 3

Breast Cancer

# of studies = 93

# of positive results = 82

# of inconclusive results = 5

# of negative results = 6

Diabetes

# of studies = 114

# of positive results = 100

# of inconclusive results = 9

# of negative results = 5

Endometriosis and Adenomyosis

# of studies = 12

# of positive results = 9

# of inconclusive results = 3

# of negative results = 0

Polycystic Ovary Syndrome (PCOS)

# of studies = 9

# of positive results = 3

# of inconclusive results = 5

# of negative results = 1

Hyperthyroidism and Graves’ Disease

# of studies = 4

# of positive results = 3

# of inconclusive results = 1

# of negative results = 0

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Summary

We know that the endocannabinoid system (ECS) plays a key role in keeping the human body’s processes in balance (homeostasis). Therefore, it stands to reason that the ECS influences the endocrine system and how hormones behave, seeing as hormones are the human body’s chemical messengers, telling us when to eat, sleep, and reproduce. So, as the ECS is involved in regulating hormones, it comes as no surprise that it is important for:

  • Increasing or decreasing appetite
  • The sleep-wake cycle
  • Growth and reproduction
  • Increasing or decreasing stress hormones
  • Regulating mood and emotions
  • Regulating energy and metabolism

As endocannabinoid dysfunction and clinical endocannabinoid deficiency [1] impacts hormone levels, medical cannabis could be useful for managing the following conditions:

Pros

Cons

  • Cannabis may negatively impact fertility in both men and women [6].
  • Little is known about the impact of long-term cannabis use on the endocrine system as a whole.
  • Cannabinoids from cannabis (phytocannabinoids) could stimulate the production of some hormones and inhibit the production of others. This can be both negative and positive, depending on the condition. For example, it is theoretically possible that cannabis use may promote the progression of some types of cancer [7].

The ideal “strain” (cultivar) depends very much on the person’s physiology and the condition/s they are trying to manage. What works for one person may not work for another, and dosing requirements can also vary. Different people may require specific chemotypes (cannabinoid-terpene-flavonoid profiles) to manage their health problem/s.

Some suggested cannabis varieties include:

  • Harlequin, for its CBD content, modest THC content, and uplifting, energizing effects.
  • Jillybean, for its ability to manage strains and cramps.
  • Sour Tsunami, for its high THCV content, which can help reduce appetite.
  • Northern Lights, for its relaxing, pain-relieving, sleep-inducing properties.
  • Blue Dream, for its balanced effects, including both cerebral stimulation and full-body relaxation.
  • Pink Kush, for its ability to manage stress and improve appetite.

Could Medical Cannabis Help?

There is a lot of conflicting information regarding cannabis and its impact on the endocrine system. Some studies show that cannabis could disrupt [8] the hypothalamic-pituitary-thyroid (HPT) axis, whereas other studies [9] show that cannabis use has little effect on thyroid function overall.

However, it is clear that the two systems do interact in several ways, especially as both are involved in several important functions, such as appetite regulation, sleep, and growth. With this in mind, here are some answers to some of the most common questions about cannabis and its effect on the body’s hormones.

What hormones does cannabis affect?

It is suggested that the endocannabinoid system oversees every or almost every neurotransmitter and hormonal system [10] in our body. The sleep-wake cycle, appetite, reproduction, and many other processes that involve hormones also involve the endocannabinoid system. This means that cannabis can affect how all hormones in the body behave.

Does cannabis have a positive, neutral, or negative effect on hormones?

This is difficult to answer, as what could be a positive effect for one person might be a negative effect for another. Someone who has a low appetite due to a health problem could find the appetite-stimulating effects of cannabis helpful. In contrast, someone who is managing obesity and diabetes may want to avoid using too much THC as they want to curb their appetite, not increase it.

So, whether cannabis has a positive or negative effect on hormones generally depends on what health concern you are using medical cannabis for.

What effect does cannabis have on hunger hormones?

One of the most noted effects of cannabis is its ability to stimulate your appetite — aka “getting the munchies.” This is because cannabis, particularly THC, stimulates the hormone ghrelin [11], which encourages hunger and feeding. Interestingly, cannabis users have lower leptin levels [12]. Leptin regulates food intake and energy expenditure, which could help explain why cannabis users have lower body fat percentages.

Interestingly, cannabinoids like tetrahydrocannabivarin (THCV) and cannabigerol (CBG), as well as terpenes like humulene, could help curb appetite, which makes some types of cannabis useful for reducing hunger and managing weight.

What effect does cannabis have on insulin?

Insulin is the hormone responsible for regulating glucose throughout the body. In non-diabetics, insulin circulates in the blood, transporting glucose into cells for fuel. In diabetics, cells become resistant to insulin, and glucose is not transported into cells efficiently. This causes large spikes in blood sugar which, over time, causes damage to nerves.

CBD is linked to improved glucose metabolism [13], and one study [ibid.] shows that THC can also blunt insulin spikes. This suggests that cannabis can help manage diabetes if used appropriately. Moreover, although THC can increase appetite, it can still be useful for those managing metabolic disorders (obesity, diabetes, hypertension) if combined with the appropriate lifestyle changes.

What effect does cannabis have on stress hormones?

Many people find that cannabis can reduce stress and chill them out. However, for those new to cannabis or those who have taken a long break, THC actually increases cortisol levels [14] in the initial stages. This can increase blood pressure and anxiety. Those who use cannabis regularly become habituated to the spike in cortisol, which dulls response to acute stress over time [15].

Does cannabis affect fertility?

Cannabis stimulates the release of the “hugging hormone,” oxytocin. Oxytocin is responsible for reproductive functions like uterine contractions during labor and breastfeeding, and the satisfaction people experience during positive social interactions.

There is some evidence that cannabis can reduce both male and female fertility. Cannabis could possibly reduce female fertility [16], “by disrupting the hypothalamic release of gonadotropin-releasing hormone (GnRH), leading to reduced estrogen and progesterone production and anovulatory menstrual cycles.” Female cannabis users may also experience dose-dependent impairment in ovarian function and a decrease in estradiol.

Preclinical evidence suggests that cannabis has a similar effect on male fertility. One study [17] shows a 29% decrease in sperm count, and other studies [18] have shown similar findings. However, one 2019 study [19] shows that men who smoked cannabis actually had higher sperm counts than those who had never smoked cannabis.

However, it must be noted that most of these studies on the impact of cannabis on fertility are carried out on animals, not humans. This means that, although these findings are useful, they do not always reflect in humans.

Does cannabis affect libido?

Yes, although the effects seem to be mixed. In one study [20], cannabis appears to boost the female sex drive, with 68.5% divulging that their overall sexual experience was more pleasurable, 60.6% reporting an increase in sex drive, and 52.8% sharing that they had experienced an increase in satisfying orgasms.

The opposite seems to be the case in men, at least regarding long-term cannabis use. It is possible [21] that short-term cannabis use in the appropriate doses can relieve stress and boost male libido. Still, research also shows [22] that male cannabis users may be more likely to experience erectile dysfunction and a decrease in libido and sexual pleasure.

So, there is no definitive answer to how cannabis affects libido. Cannabis may reduce sexual appetite in men and increase it in women, but the studies are inconclusive.

Is there a difference between the effects of THC and the effects of CBD on hormones?

There are few studies looking at the effects of different cannabinoids. One study [23] shows that CBD reduces cortisol levels, helping mitigate stress.

Whether CBD increases or decreases thyroid hormones might depend on someone being hypothyroid, hyperthyroid, or having a normal thyroid.

Anandamide was found [24] to suppress TSH only in hypothyroid and normal thyroid conditions (high TSH), and not in hyperthyroid conditions (low TSH).

CBD suppresses estrogen production directly [25] by inhibiting an enzyme that makes it from testosterone, called aromatase. Aromatase inhibitors are used [26] to reduce estrogen levels in cases of breast cancer and postmenopause.

As for growth hormones, CBD does not [27] seem to have an effect. THC, on the other hand, may reduce the production of growth hormone (GH). One study [28] shows that THC reduces GH secretion from the pituitary gland via cannabinoid receptor 1 and reduces circulating GH levels in adults.

Does cannabis reduce testosterone?

Research on this shows conflicting results [29]. Cannabis does not seem to influence testosterone levels in infertile men based on the current literature. Some studies show a decline in testosterone levels, and others show an increase in testosterone levels. As such, there is no definitive answer to this question as of yet.

Can cannabis help treat breast cancer?

With estrogen-positive breast cancer, too much THC may be best avoided, as it can increase estrogen levels. CBD may be a better choice in such an instance, but we shouldn’t necessarily get rid of THC entirely. This is because THC has many cancer-beating properties. Therefore, it is considered important to match the THC:CBD ratio to the type of cancer you’re treating.

However, there is no evidence that using THC can cause breast cancer, and there is little evidence to suggest that it may treat it. However, CB2 expression was highly associated [30] with human epidermal growth factor 2 positive (HER2+) tumors but not hormone receptor-plus (HR+) or triple-negative breast cancer. This suggests that medical cannabis could theoretically be used to manage HER2+ tumors, but more research is needed in this area.

Can cannabis affect the menstrual cycle?

One study [31] found that those who co-used cannabis and tobacco had a shortened luteal phase compared to those who only used tobacco. Another study [32], however, found that, in a cohort of premenopausal women, occasional or frequent marijuana use was associated with a 2.75-day increase in follicular phase length compared to participants who did not use cannabis. This suggests that cannabis may delay ovulation and increase the incidence of anovulatory cycles, where you don’t ovulate at all. This suggests that, as noted above, frequent use of cannabis may increase the likelihood of infertility.

However, the research so far is not conclusive, so we do not know what impact cannabis has on the menstrual cycle in any great detail.

Can cannabis affect hormone replacement therapy (HRT)?

Considering that cannabis can affect your hormones in many ways, it would be quite logical to think that cannabis affects HRT. However, there is little research on the combination of cannabis or CBD and HRT, and anecdotal evidence suggests that cannabis or CBD does not affect HRT in any way.

Can cannabis be used to manage symptoms associated with premenstrual syndrome (PMS) or menopause?

An increasing number of women are turning to cannabis or CBD to manage [33] cramps, anxiety, mood swings, insomnia, and joint pain associated with PMS, premenstrual dysphoric disorder (PMDD), or menopause. More research is needed in this area, but reports are generally positive.

Conclusion

Overall, we understand little about cannabis’ impact on hormones and the endocrine system. Both the ECS and the endocrine system are complex and are responsible for a number of bodily functions. Sometimes, the two systems interact. Other times, they may not. A great deal more research is still needed in this area.

References

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