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The effect of tetrahydrocannabinol on testosterone among men in the United States: results from the National Health and Nutrition Examination Survey



To determine the association between tetrahydrocannabinol (THC) use and testosterone (T) levels among men in the United States.


Using the National Health and Nutrition Examination Survey (NHANES) data from the years 2011–2016, we identified all men 18 years and older who answered the substance use questionnaire and underwent laboratory testing for T. Regular THC users were defined as those who use THC at least one time per month, every month for at least 1 year. Multivariable linear regressions controlling for confounders were then used to determine the relationship between THC use and T levels.


Among the 5146 men who met inclusion, 3027 endorsed using THC at least once in their life (ever-user). Nearly half of the THC ever-users (49.3%) were considered regular THC users. Multivariate analysis controlling for age, comorbidities, tobacco use, alcohol use, body mass index (BMI), exercise level, and race revealed a small but statistically significant increase in T among regular THC users at any measured level of use, compared to non-regular THC users (non-users). This increase was characterized by an inverse U-shaped trend with Regular THC users using two–three times per month demonstrating the greatest increase in T (+ 66.77 ng/dL) over non-users.


THC use is associated with small increases in testosterone. This increase in T appears to decline as THC use increases, but nevertheless, T is still higher with any amount of regular use when compared to T in non-users. Prospective work is needed to validate the observed increase and to better elucidate the mechanism of impact THC use has on T levels.

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Authors and Affiliations



RJF: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. SDL: protocol/project development, data collection or management, and manuscript writing/editing. TPK: protocol/project development, data collection or management, and data analysis. RR: protocol/project development, data collection or management, data analysis, and manuscript writing/editing.

Corresponding author

Correspondence to Ranjith Ramasamy.

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Conflict of interest

Author R Ramasamy has the following potential disclosures: Coloplast—Consultant, Boston Scientific—Investigator, Endo—Investigator, Advisory Board, Aytu Biosciences—Investigator, Advisory Board, Direx—Investigator. Authors RJ Fantus, SD Lokeshwar, and TP Kohn have no conflicts of interest to declare.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (National Health And Nutrition Examination Survey, NCHS IRB/ERB Protocol Number: NHANES 2017–2018: Protocol #2018-01 (Effective beginning October 26, 2017), Continuation of Protocol #2011-17 (Effective through October 26, 2017), NHANES 2015–2016: Continuation of Protocol #2011-17, NHANES 2013–2014: Continuation of Protocol #2011-17, NHANES 2011–2012: Protocol #2011-17) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. Health information collected in the NHANES is kept in strictest confidence. During the informed consent process, survey participants assured that data collected will be used only for stated purposes and will not be disclosed or released to others without the consent of the individual or the establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m).

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Fantus, R.J., Lokeshwar, S.D., Kohn, T.P. et al. The effect of tetrahydrocannabinol on testosterone among men in the United States: results from the National Health and Nutrition Examination Survey. World J Urol 38, 3275–3282 (2020).

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  • Testosterone
  • Tetrahydrocannabinol
  • Marijuana