Abstract
Marijuana is one of the most consumed drugs worldwide. There is increasing evidence of an association between marijuana and male infertility. This study intends to assess the repercussion of marijuana smoking and other habits (sedentary lifestyle, alcohol, and tobacco use) in the testicular function of infertile men seeking andrological evaluation. A retrospective study was performed using medical records data of men aged 18–59 years from 2009 to 2017. Complete semen analyses, sperm functional tests, SHBG, and hormonal levels, testosterone-to-estradiol ratio (T/E2), and testis volume were evaluated. Exclusion criteria included cryptorchidism, infertility caused by genetic or infectious diseases, and cancer. A multiple linear regression analysis was performed to investigate which habit could predict certain parameters using the software SPSS 23.0 (P < 0.05). In a sample of 153 men, semen parameters, testosterone levels, and testis volume were not significantly influenced. Marijuana use had the broader hormonal changes since it influences estradiol (P = 0.000; B = −11.616), prolactin (P = 0.000; B = 3.211), SHBG levels (P = 0.017; B = 7.489), and T/E2 (P = 0.004; B = 14.030). Sedentary lifestyle (P = 0.028; B = 1.279) and tobacco smoking (P = 0.031; B = −2.401) influenced the prolactin levels. Marijuana is associated with hormonal imbalance in this infertile cohort by lowering estradiol levels and inhibiting aromatase function.
Highlights
Produced on every continent, marijuana is one of the most widely consumed drugs with ∼188 million users or 3.8% of the world’s population between 15 and 64 years of age (1)
Current evidence seems conflicting regarding the effects of cannabis on male reproductive endocrine function, with an emphasis on the inconclusive findings in testosterone levels, concomitant with reduced luteinizing hormone (LH) and unchanged follicle-stimulating hormone (FSH) concentrations (7–12)
The assessment included a mandatory measurement of testicular volume (TV) using an ultrasound with calculated TV deduced from the ellipsoidal formula: TV = [length X width X depth X 0.52]
Summary
Marijuana (cannabis made from the dried flowers and leaves of the plant Cannabis sativa) is one of the most widely consumed drugs with ∼188 million users or 3.8% of the world’s population between 15 and 64 years of age (1). The male reproductive function has been the subject of particular attention in recent years due to the accumulation of data on a possible deterioration in sperm counts and quality related to various environmental and behavioral factors (4). Among the wide range of environmental factors that can affect men’s fertility, some evidence suggests an association between chronic marijuana use and male infertility (6). Most human studies associate marijuana use with a deleterious impact on male fertility status, mainly because of the correlation with lower sperm concentrations, morphologic abnormalities, and reduced motility and viability (6–9). Current evidence seems conflicting regarding the effects of cannabis on male reproductive endocrine function, with an emphasis on the inconclusive findings in testosterone levels, concomitant with reduced luteinizing hormone (LH) and unchanged follicle-stimulating hormone (FSH) concentrations (7–12). The study reported here aims to evaluate the effects of marijuana, within other conditions (obesity, sedentary lifestyle, smoking, alcohol consumption), on the spermatozoa function and sex hormone levels in reproductive failure situations in patients attending an andrology setting
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