Sex differences in the acute effects of cannabis on human cognition: A systematic review.
Justin Matheson, Danial Behzad, Christina Zakala, Thomas Hawken, Bruna Brands, Bernard Le Foll, Christine M Wickens, Anthony C Ruocco, Terri Rodak, Patricia Di Ciano
Frontiers in neuroendocrinology October 1, 2025 DOI: 10.1016/j.yfrne.2025.101215 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Sample size | 29 |
| Population | Humans (studies of acute cannabis or THC effects on cognition) |
| Topics | Cannabis |
| Keywords | Cognition Sex differences |
| Citations | 5 |
| Key findings | Only 20.7% of reviewed studies found any sex differences in acute cognitive effects of cannabis, with all showing greater impairment in female participants for at least one outcome. |
Abstract
Acute cannabis exposure can transiently impair cognitive performance, increasing the risk of accidental injury and potentially disrupting activities of daily living. Although sex differences in responses to cannabis have been reported, no systematic review has examined whether these extend to acute cognitive effects. Our primary aim was to examine sex differences in the acute effects of cannabis (including isolated delta-9-tetrahydrocannabinol [THC]) on cognition in humans. Our secondary aim was to determine if sex differences in the acute effects of cannabis vary by cognitive domain, route of administration, or dosing paradigm. Following PRISMA guidelines, we conducted a comprehensive literature search across Embase, MEDLINE, APA PsycInfo, Cochrane Library, and Web of Science databases. Of 1,625 unique records, 169 underwent full-text screening, and 29 studies met inclusion criteria. Six of 29 articles (20.7 %), representing eight of 216 cognitive outcomes (3.7 %), found statistical evidence of sex differences in acute cognitive effects of cannabis/THC. All six found increased effects in female participants in at least one cognitive variable; one study additionally found increased effects in male participants, and one study found divergent cognitive effects in male and female participants. There were no clear patterns by cannabis dosing paradigm, route of administration, or cognitive domain. Overall, we found limited evidence that sex significantly influences the acute cognitive effects of cannabis, though methodological heterogeneity precludes any firm conclusions. Future studies should prioritize the measurement of sex-related factors, such as hormonal modulation of cannabinoid pharmacokinetics and pharmacodynamics.
Comparable studies
Other systematic reviews and meta-analyses on cannabis, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Effects of cannabis use on outcomes of psychotic disorders: systematic review People with psychotic disorders, as examined in 13 longitudinal studies | 2008 | Systematic review | |
| The Impact of Cannabis Use on Cognitive Functioning in Patients With Schizophrenia: A Meta-analysis of Existing Findings and New Data in a First-Episode Sample Patients with established schizophrenia (meta-analysis: 572) and patients with... | 2010 | Meta-analysis and cross-sectional observational study | n = 700 |
| Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review | 2020 | Systematic review | |
| Neuroimaging in cannabis use: a systematic review of the literature Cannabis users and controls in neuroimaging studies | 2009 | Systematic review | |
| Human Laboratory Studies on Cannabinoids and Psychosis. Healthy human subjects and individuals with schizophrenia | 2016 | Systematic review |
Citations in the library
Cites 21
- Sex differences in acute cannabis effects revisited: Results from two randomized, controlled trials Addiction Biology December 22, 2021
- The altered state of consciousness induced by Δ9-THC. Consciousness and Cognition May 28, 2022
- Effects of acute cannabis inhalation on reaction time, decision-making, and memory using a tablet-based application Journal of Cannabis Research February 3, 2024
- Does cannabidiol make cannabis safer? A randomised, double-blind, cross-over trial of cannabis with four different CBD:THC ratios Neuropsychopharmacology November 16, 2022
- Sex Differences in the Neuropsychiatric Effects and Pharmacokinetics of Cannabidiol: A Scoping Review. Biomolecules October 12, 2022
and 16 more in the library