Italy: In a cohort of primary infertile non-Finnish, white-European men, researchers found that the use of cannabis led to a higher risk of low testosterone levels and altered sperm morphology (teratozoospermia) compared to the non-users. The study was published in Andrology.
Infertility is defined as the failure to achieve a pregnancy after 12 months or more. Epidemiology of infertility data reports, that one in 4 couples in developing countries are affected by infertility, and approximately 48.5 million couples experience infertility worldwide. Male factor contributes to up to 50% of cases of couples experiencing infertility. Cannabis is one of the most commonly used recreational drugs. The active component of cannabis, D9-tetrahydrocannabinol (THC) binds to the cannabinoid receptors in the brain, the nervous system, and, among other locations, the reproductive organs. The effect of cannabis on the reproductive system has been largely debated in the literature.

Belladelli F, University Vita-Salute San Raffaele, Milano, Italy, and his team initiated a study to evaluate the effect of recreational cannabis use on total Testosterone (tT) levels, gonadal status, and sperm parameters
Researchers analyzed data from 2074 men who visited primary couples' infertility. Lifestyle factors and cannabis use were investigated in all participants. Semen analyses were based on the 2010 World Health Organization reference criteria. Serum hormones were evaluated, and patients were subdivided based on their gonadal status. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Descriptive statistics and linear regression analyses were used to test the association between cannabis use, sperm parameters, and hormonal levels. Logistic regression analyses tested potential predictors for abnormal sperm parameters and gonadal status.
Key findings of the study,
• Of the total, 10.9% of the patients reported cannabis use in their lifetime.
• Total Testosterone levels were lower in cannabis users than nonusers (p = 0.03).
• In a multivariable linear regression analysis, cannabis use was inversely associated with tT levels but not with follicle-stimulating hormone or luteinizing hormone levels.
• Conversely, in a multivariable logistic regression model, cannabis use was not associated with the type of hypogonadism.
• At multivariable linear regression analysis, cannabis use was inversely associated with sperm morphology, while not with both sperm concentration and sperm motility.
• At adjusted logistic regression analysis, cannabis use was associated with teratozoospermia but not with oligo-, astheno-, and azoospermia.
The authors conclude that the use of cannabis may increase the risk of having lower testosterone levels and altered sperm morphology in infertile males. It should be avoided for better reproductive health. Also, a thorough social history and careful counseling are needed for men with male factor infertility who use recreational cannabis.
Reference:
Belladelli F, Fallara G, Pozzi E, Corsini C, Cilio S, Raffo M, d'Arma A, Boeri L, Capogrosso P, Eisenberg M, Montorsi F, Salonia A. Effects of recreational cannabis on testicular function in primary infertile men. Andrology. 2022 Jul 22. doi: 10.1111/andr.13235.