Erectile Dysfunction and Cannabis Abuse: What the Latest Data Reveal

Understanding cannabis and men's sexual health

Most people know cannabis for its relaxing effects. Some use it medically for pain, nausea, or anxiety. ^[3] But our bodies rely on a delicate balance of hormones and blood flow to achieve and maintain an erection. Testosterone, the key male hormone, fuels libido and energy. Healthy blood vessels carry the rapid surge of blood that makes an erection possible. When either hormones or blood vessels are out of sync, erectile dysfunction can follow. ^[4]

Research from small labs hinted that heavy cannabis use could upset this balance. Animal studies showed THC, cannabis’s active ingredient, interferes with hormone signals in the brain and testes. ^[5] Other trials suggested that long-term use harms the lining of blood vessels. ^[6]

Until now, we have lacked a comprehensive, real-world picture of how these lab findings affect everyday men.

The study at a glance

A team led by Davis and colleagues tapped into the TriNetX US Collaborative Network, a massive database of de-identified health records covering more than 115 million people. They identified men aged 18 and older who had a coded diagnosis of cannabis abuse or dependence. Then they matched each of those men to a similar man without such a diagnosis, balancing factors like age, race, smoking history, and other health conditions. ^[2]

They split the analysis into two time windows. First, they looked at what happened within one year of diagnosis. Second, they checked outcomes three to five years later. The main questions were simple: How many men went on to get a medical code for erectile dysfunction (ED)? How many showed low testosterone on lab tests? They also tracked prescriptions for standard treatments, like erectile dysfunction type pills like Viagra and testosterone injections. ^[2] 

To make sure their results weren’t just the product of more doctor visits, they included a “null” comparison, urethral strictures, a condition unrelated to cannabis use.

Key findings explained

Within the first year after a cannabis abuse or dependence diagnosis, nearly four times as many men developed ED compared with the matched controls (0.9 percent vs. 0.2 percent; RR = 3.99). ^[2] That means if 100 men without problematic cannabis use saw two cases of ED, you’d expect eight or nine cases of ED among 100 men with heavy cannabis problems. Likewise, low testosterone occurred more than twice as often in the heavy-use group (0.2 percent vs. 0.1 percent; RR = 2.19). ^[2]

Those percentages may sound small at first glance. But ED affects millions of men, and even small increases signal significant trends when you scale up to the population level. Prescriptions for erectile-support medications rose nearly fourfold, mirroring the rise in diagnoses. Testosterone treatments did not increase, suggesting doctors may not always link low testosterone to cannabis use right away. ^[2]

When researchers looked out five years, the picture changed a bit. The gap in ED diagnoses narrowed but remained significant (1.6 percent vs. 1.3 percent; RR = 1.20). Low testosterone and prescriptions no longer differed significantly, implying that most of the risk shows up early. ^[2]

Splitting men by age revealed that men over 40 carry the most significant short-term risk. In that group, short-term erectile issues jumped more than fourfold, and low testosterone cases doubled. Younger men under 40 also faced a higher risk but saw no lasting effects after a year. ^[2]

Why these results matter

First, this is the largest real-world evidence to date linking serious cannabis use with men’s sexual problems. Lab work and small trials hinted at a connection, but this analysis confirms it at scale, even though it does not prove causality.

Second, the biggest risk appears within the first year. That window offers early intervention opportunities if clinicians and patients know what to watch for—third, age matters. Men over 40 already face gradual hormone and blood vessel changes; adding heavy cannabis use seems to speed up that decline. ^[2]

From a public health view, even a modest bump in ED means many more men could experience distress, relationship strain, or reduced quality of life. Erectile problems can also signal broader cardiovascular issues. Low testosterone brings fatigue, depression, and loss of muscle mass. ^[7] Awareness of these links helps doctors and men address risks before they become entrenched.

What does this mean for you

If you use cannabis regularly, especially daily or almost daily, pay attention to your sexual health. Notice any changes in your erections, libido, or energy levels. Be frank with your doctor about your cannabis habits. Many patients underreport substance use, fearing judgment. However, your healthcare provider must see the full picture to guide testing or treatment.

If you begin to experience erectile difficulties, ask whether your cannabis use could be a factor. Moderation may reduce risk: occasional use carries far less risk than chronic, heavy consumption. Some men find erections and testosterone rebound after a few weeks off cannabis. ^[2]

We still need prospective trials to confirm reversibility, but anecdotally, many men report improvement after scaling back.

Questions to ask your doctor

Bringing up cannabis use with a healthcare provider can be uncomfortable, but the right questions can open the door to more tailored care. If you're experiencing symptoms like low libido, energy dips, or erectile difficulties, consider raising one or more of the following:

• “Could my cannabis use be affecting my sexual health?”
  This question invites a nonjudgmental conversation and helps your doctor consider all possible contributors.
• “Would it be useful to check my testosterone levels?”
  Fatigue, mood shifts, and reduced libido are often tied to hormone changes—testing can reveal if imbalances are at play.
• “Are there medical cannabis alternatives with fewer sexual side effects?”
  This helps you explore treatment options that support your broader health goals.
• “If I take a break from cannabis, how long before things improve?”
  Some men notice benefits within weeks; your doctor may help you set realistic expectations and monitor changes.

Practical steps for healthy choices

First: Track your cannabis use.

• Note frequency, method (smoking vs. vaping vs. edibles), and dosage. Small changes can make a big difference: switching from daily to a few times a week may cut your risk substantially.

Second: Support your blood vessels and hormones with proven lifestyle habits.

• Exercise regularly, especially cardio, to boost nitric oxide and blood flow.
• Eat a balanced diet rich in fruits, vegetables, and whole grains if you can.
• Manage stress through mindfulness, therapy, or hobbies.

Third: Ask for a testosterone test if you’re feeling off. Early treatment can restore balance and prevent more serious issues.

If you decide to taper or pause cannabis, seek support. Behavioral therapies, peer groups, or digital apps can help you reduce use without abrupt withdrawal. Your doctor can also guide safer strategies to manage pain or anxiety with lower-risk alternatives.

Looking ahead: Research and hope

This study opens the door to a better understanding of how cannabis interacts with our bodies beyond the brain. Future research will help answer critical questions: How much use triggers these risks? Do all forms of cannabis carry the same danger? And perhaps most importantly, can erections and testosterone recover fully after quitting? Early lab work and small studies are promising, but we need large, prospective trials to guide clear recommendations.

In the meantime, these findings serve as a necessary caution. Cannabis may help in many ways, but heavy, ongoing use is not risk-free. Being informed lets you weigh benefits against potential costs—and take steps to protect your sexual health as legalization continues to spread.

Bottom line

The rise of cannabis legalization brings both opportunity and responsibility. If you or someone you know uses cannabis regularly, pay attention to changes in sexual function. ED and low testosterone may emerge within months of heavy use, especially for men over 40.

By tracking your habits, talking openly with your doctor, and supporting your vascular and hormonal health, you can enjoy cannabis’s possible benefits while reducing its potential downsides. As research unfolds, staying informed and proactive will remain the best strategy for safeguarding men’s sexual well-being.