Are there sex differences in how cannabis affects men and women?

Significant sex differences exist in cannabis pharmacology, largely driven by estrogen-mediated modulation of the ECS. Key findings: (1) Sensitivity: Women are more sensitive to THC's analgesic effects during high-estrogen phases of the menstrual cycle — estrogen upregulates CB1 receptor expression. (2) Tolerance: Women develop tolerance to THC's analgesic effects faster than men. (3) Addiction risk: Women progress from first use to cannabis use disorder faster than men ("telescoping effect"), despite typically using less cannabis. (4) Cognitive effects: Some studies show greater acute cognitive impairment in women. (5) Anxiety: Women report more anxiety and paranoia from THC at equivalent doses. (6) Withdrawal: Women report more severe withdrawal symptoms. These differences have important clinical implications — most cannabis research has been conducted predominantly in male subjects, limiting generalizability.