Cannabis & testosterone: effect on male fertility

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The most important thing: Daily cannabis use is a problem when trying to conceive: Gundersen 2015 shows up to 52% lower sperm concentration. All effects are reversible after 3 months of abstinence – spermatogenesis takes 74 days.
At a glance:
  • Weekly consumption: 28% lower sperm concentration (Gundersen 2015, n=1215)
  • All sperm effects completely reversible after 3 months of abstinence
  • Women: Cannabis impairs egg maturation and luteal phase – no use if you want to have children

Cannabis and the male hormone system

Overview hide
Cannabis and the male hormone system
Effects of THC on male hormones
Study situation: cannabis and testosterone
CB1 on sperm: Direct effect
What does this mean in practical terms for the desire to have children?
FAQ: Cannabis and testosterone
Summary

Testosterone and male fertility are a relevant topic for cannabis users. The endocannabinoid system is directly integrated into the hypothalamic-pituitary-gonadal (HPG) axis, which regulates testosterone and sperm production. CB1 receptors are found in the hypothalamus, pituitary gland and testes.

Effects of THC on male hormones

Parameters Acute THC effect Chronic THC effect Recovery after abstinence
Testosterone (total) Slight transient reduction With high consumption: 10-30 % reduction 4-8 weeks until normalization
LH (luteinizing hormone) Pulsatile LH release dampened Reduced LH amplitude 4-6 weeks
Sperm count No acute effect Reduction with high consumption (50 % daily consumers) 3-4 months (sperm maturation takes 74 days)
Sperm motility No acute effect Reduced with daily consumption 3 months
Sperm morphology No acute effect Increased proportion of morphologically abnormal sperm 3 months

Study situation: cannabis and testosterone

Kolodny et al. 1974 (NEJM): First large study. Daily cannabis users had significantly lower testosterone levels than non-users. Study with methodological weaknesses; but fundamentally important.

Gundersen et al. 2015 (Am J Epidemiol): n=1215 young Danish men. Weekly cannabis use associated with 28% lower sperm concentration vs. non-users. Daily use + other drug use: up to 52 % reduction.

Hall et al. 2021 (Human Reprod): No statistically significant association between cannabis use and sperm parameters in younger cohort. Conflicting data confirmed.

Current consensus (2024): Moderate, occasional cannabis use probably has minimal effect on fertility. Daily use, especially >10 mg THC/day, is associated with hormonal and sperm changes. Effects are reversible with abstinence.

CB1 on sperm: Direct effect

Sperm cells express CB1 receptors. Anandamide directly modulates the acrosome reaction (necessary for oocyte penetration) and sperm motility:
– Low anandamide levels: stimulating for motility
– High anandamide/THC levels: inhibitory for motility

THC competes with anandamide for CB1 on sperm – direct inhibition of sperm function has been proven.

What does this mean in practical terms for the desire to have children?

If you actively wish to have children:
– Abstinence from cannabis containing THC at least 3 months before the planned attempt to conceive
– Sperm maturation takes 74 days – all sperm produced today will only be ready for ejaculation in 74 days
– CBD: no relevant negative effects on fertility proven

Study highlight: Gundersen 2015 (Am J Epidemiol, n=1215 Danish men): Weekly cannabis use = 28% lower sperm concentration. Daily use + other drugs = up to 52 % reduction. After 3 months of abstinence, the values normalized completely.

FAQ: Cannabis and testosterone

Summary

THC has negative effects on testosterone (up to -30 %) and sperm parameters with daily use via CB1 in the HPG axis and directly on sperm. Gundersen 2015 shows -28 % sperm concentration with weekly use. All effects reversible after 4-8 weeks (hormones) or 3 months (sperm). If you want to have children: 3 months abstinence. CBD has no relevant negative fertility effects. Tolerance break for abstinence tips; CBD vs. THC for the fundamental difference.

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