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Hormone therapies are used to treat a variety of conditions ranging from menopause to health-threatening hormone imbalances to gender transition therapies and even cancer. Now, recent discoveries about the endocannabinoid system (ECS) and the production of hormones reveal new ways in which cannabis compounds can affect hormone-related conditions and the therapies that treat them.
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Hormones 101
Hormones are produced and expressed in the same way for both men and women, although different hormones predominate for each sex—and those differences also play a role in how cannabis affects hormone-related conditions and therapies.
The hormone system is really part of a larger network of transmitters called the endocrine system, which also includes the thyroid, parathyroid and adrenal glands. Hormone production itself is controlled by activity in the pituitary gland and hypothalamus. The pituitary gland along with the hypothalamus is also called the hypothyroid-pituitary-gonadotropin axis (HPG axis) and is responsible for triggering the release of gonadotropin releasing hormone (GnRH).
The HPG axis also stimulates the production of both follicle stimulating hormone (FSH) and luteinizing hormone (LH) and when FSH and LH act on the gonads, they lead to the production of a number of hormones including estrogen estradiol, progesterone, androgen and testosterone.
Although hormones are most directly involved in expressing sex differences and supporting reproduction, they also play a role in regulating many other processes in the body. Hormones affect the development of bones and muscle, support brain health and more. Imbalances in the endocrine system can lead to a variety of diseases, including diabetes and thyroid problems.
As far back as the 1980s, studies have shown a connection between cannabis and hormones. With the discovery of the ECS in the early 1990s, the reasons behind that connection are becoming increasingly clear—and posing new questions at the same time.
Cannabinoids Affect Hormones in Complex Ways
The ECS is closely entwined with all other major neurotransmitter signaling systems in the body, including the endocrine system. That’s why cannabinoids, either the body’s own anandamide and 2-AG, or compounds from cannabis can affect the production and behavior of hormones both in the reproductive system and in other circumstances, such as the development of cancer.
The ECS is a large, dense network of receptors located in the organs, tissues and brain. Those receptors respond both to cannabinoid chemicals produced by the body and the many compounds found in the cannabis plant, particularly tetrahydrocannabinol (THC) and cannabidiol (CBD). Because the compounds in cannabis are so similar to those produced naturally in the body, cannabis products of all kinds can have profound effects on many different processes, including the workings of the endocrine system and the production and expression of hormones.
Some research suggests that the ECS might in fact play a major role in the production of hormones in the HPG axis. The hypothalamus is rich in the cannabinoid receptor CB1, as is parts of the pituitary gland as well as other components of the endocrine system. Plus, both the ovaries and testes contain large numbers of cannabinoid receptors, too.
Menopause & Hormone Replacement Therapy
For a number of women, menopause—that midlife change when fertility declines and eventually ends as menstrual periods come to a stop—brings a range of symptoms including hot flashes, mood swings, insomnia and problems concentrating, as hormone levels begin to decline and become imbalanced. In perimenopause—the years leading up to full menopause—some women can experience all those symptoms, plus painful and irregular periods, even if they never had period problems before.
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To relieve these symptoms and allow sufferers to conduct normal lives, doctors frequently prescribe hormone replacement therapy (HRT), a protocol that’s intended to replace declining levels of reproductive hormones. But this kind of therapy brings with it a heightened risk of cancer, especially breast cancer.
Women at a higher risk for certain kinds of cancers are usually advised not to take HRT, or to keep the treatments short—and some doctors are advising patients not to do it at all. Many women on their own are deciding in favor of more natural alternatives for the ills of menopause, even if they aren’t sure what those remedies might be.
An increasing number of women are finding that cannabis products can help relieve menopause symptoms without the risk of HRT’s harmful effects. Marijuana can even be used to replace hormone therapy altogether for some people—or allow users to reduce their dose.
Cannabis, especially its non-psychoactive component CBD, can affect cannabis receptors in the brain and reproductive system to block pain, regulate the body’s temperature to avoid hot flashes, and generally do the things HRT can do—but without the potentially deadly side effects. And because doctors frequently prescribe other drugs such as sleep aids and antidepressants along with HRT, marijuana can reduce or eliminate the need for those additional drugs, too.
Cannabis has a wide range of benefits for women’s reproductive health in general, from easing the discomfort of breast tenderness and painful menstrual cramps during a woman’s cycle to reducing symptoms after menopause such as vaginal dryness. Some research suggests that an endocannabinoid deficiency might be the cause of early menopause and some of the severe symptoms associated with menstruation and menopause in general, so cannabis products might eliminate the deficiency—and with it, the need for HRT and other medications for treating menstrual and menopause symptoms.
Supplemental Hormone Therapies
The potential use of cannabis for menopause-related hormone therapy symptoms has been relatively well studied, but less research has been done on its benefits and risks for other situations where hormone therapy is used. Still, recent discoveries about the relationship between cannabis and hormones can reveal more about the contribution cannabis can make in those situations.
Hormone therapy is used to supplement hormone production when it’s out of balance, or the body simply doesn’t make enough essential hormones on its own. That kind of deficit can lead to growth abnormalities, bone deformities and problems with muscle tone—and it can affect both males and females. Because the ECS can affect the endocrine system, cannabis products, especially those high in CBD, may be able to help restore the endocrine system’s balance.
Transgender Hormone Therapies
Transgender individuals typically take a number of cross-sex hormones as part of their transition, and most people take them for life. For transgender men, that can include injections, timed release implants or oral doses of testosterone and androgen, along with other medications to suppress female hormones. For transgender women, medication protocols include high doses of estrogen and anti-androgens to suppress masculine features.
Hormone therapies can play an important role in a transgendered person’s mental health and overall well-being, but these treatments come at a cost. High doses of hormones and related medications to suppress some of them can cause a range of health problems including reduced bone density, heart problems and deep vein thrombosis. Because hormone therapy for transgendered people can last for years, or a lifetime, it can also contribute to the development of certain hormone-sensitive tumors.
American research on the use of cannabis for health conditions of all kinds has been stymied by legal restrictions and public perceptions about the dangers of marijuana—and those perceptions, along with others about gender dysphoria and transitioning, also limit studies on the uses of cannabis in transgender hormone therapies.
But because cross-sex hormone therapies act on the HPG axis to affect the expression or suppression of one or more of those hormones, the effects of cannabis on the ECS may also help support heart and bone health during treatment, and also help reduce the depression and anxiety many transgendered people frequently experience.
Hormone Therapy for Cancer
Hormone therapy can be used to treat various cancers, too—but it’s used with caution. Some kinds of tumors, especially in the breast and prostate, can be hormone-responsive, meaning that high levels of some hormones, particularly estrogen, can actually encourage tumors to grow. Some research indicates that because cannabis doesn’t contain hormones, it could be used to support hormone therapy for certain cancers.
The effects of cannabis on hormones aren’t always clear or easily predictable. For example, it’s now known that high levels of estrogen seem to make people more responsive to the effects of cannabis. Some studies suggest that using large amounts of cannabis, especially when it has high concentrations of THC, might suppress the body’s production of testosterone and androgen, two hormones essential for the expression of male sexual characteristics and for fertility.
Still, the deep connections between cannabinoids and the body’s own hormone system indicate that cannabis products can play a powerful role in hormone therapy for a long list of conditions.
Photo credit: Jaime
If you’re new to cannabis and want to learn more, take a look at our Cannabis 101 post. HelloMD can help you get your medical marijuana recommendation; it's easy, private and 100% online.
