Cannabis abuse ups risks of erectile dysfunction, testosterone deficiency

Dependence on or excessive use of cannabis appears to increase the risk of erectile dysfunction (ED), testosterone deficiency (TD), and phosphodiesterase-5 inhibitor (PDE5-i) prescription, reveals a study.

A diagnosis of cannabis abuse/dependence, compared with no diagnosis, showed a significant association with ED (0.9 percent vs 0.2 percent; risk ratio [RR], 3.99, 95 percent confidence interval [CI], 3.05–5.21), TD, (0.2 percent vs 0.1 percent; RR, 2.19, 95 percent CI, 1.45–3.31), and PDE5-i prescription (0.8 percent vs 0.2 percent; RR, 3.80, 95 percent CI, 2.86–5.04) at 3 months to 1 year.

At 3 to 5 years, only ED was significantly associated with cannabis abuse/dependence (1.61 percent vs 1.34 percent; RR, 1.20, 95 percent CI, 1.01–1.43).

In Kaplan-Meier analysis, cannabis abuse/dependence correlated with a significantly shorter time to development of ED (hazard ratio [HR], 1.65, 95 percent CI, 1.47–1.85) and TD (HR, 1.34, 95 percent CI, 1.07–1.69). No association was observed between testosterone replacement therapy (TRT) and cannabis abuse/dependence.

Among individuals aged <40 years, only ED and PDE5-i prescription remained significant at 3 months to 1 year, but not at 3 to 5 years.

“Our findings support an association between cannabis abuse/dependence, ED, and TD, which providers may consider when treating patients with these diagnoses,” the authors said.

This study identified men aged ≥18 years from the large claims database, TriNetX, in 2025. Eligible patients were divided into two cohorts: diagnoses of cannabis abuse/dependence or not. These cohorts were propensity score-matched on 49 relevant factors.

The authors compared the risk of ED, TD, PDE5-i prescription, and TRT at 3 months to 1 year (patients from 2005–2024) and 3 to 5 years (patients from 2005–2020) with cannabis diagnoses. They also performed a Kaplan–Meier survival analysis to examine the differences in time to development of ED and TD.