CBD Mental Health Research Has a Gender Gap– Here’s Why That Matters

Given that CBD, a compound commonly extracted from cannabis or hemp plants, is able to provide a mild body high—without the mind-altering effects of THC (the psychoactive compound in cannabis)—it makes sense that people may be reaching for it as a means of easing anxious feelings. And while researchers we've spoken to note that there are no known negative side-effects to using CBD for this purpose, they still don't know a whole lot about how CBD oil works for anxiety. "There is very little data from rigorous scientific research on the therapeutic effects of CBD," J. H. Atkinson, MD, of the Center for Medicinal Cannabis Research at the University of California, San Diego, previously told Well+Good.

Almost all of the existing studies on CBD and mental health were conducted using only male subjects.

What they do know is that, while early research shows that CBD could be beneficial for treating anxiety, almost all of the existing studies on CBD and mental health were conducted using only male subjects. This was one of the findings of a new research synthesis on the use of CBD for treating anxiety published in Cannabis and Cannabinoid Research.

This is a problem for *many* reasons, starting with the fact that women have historically been left out of clinical research, and equal representation in studies is still lacking, even now. Another reason it's an issue is because mental health conditions, including anxiety, can present differently in women due to distinctions in brain chemistry and hormones, among other societal and cultural dissimilarities.

So, to get a better understanding of what's going on with CBD research for mental health and how gender plays a role. I talked to an author of the research synthesis, Patricia Di Ciano, PhD, an assistant professor of Pharmacology and Toxicilogy at the Univeristy of Toronto, as well as Ziva Cooper, PhD, director of the UCLA Cannabis Research Initiative and associate professor at the Jane & Terry Semel Institute for Neuroscience & Human Behavior.

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What scientists know about how cannabis impacts men and women differently and what that could mean for CBD mental health research

Science is already showing some key differences in how cannabis—which has been studied significantly more than CBD—may affect men and women due in part to sex hormones like testosterone and estrogen. "Part of the reason why this is really intriguing is because, at least with THC, that primary intoxicating component of cannabis, there's been quite a bit of data in laboratory animals showing that there are differences between males and females. And those differences are important with respect to translating how that might affect humans," says Dr. Cooper.

For example, brain studies in rats have revealed that females are more likely to become addicted to cannabis than males, and that female sex hormones also make them more sensitive to cannabis. While findings from a review of animal studies, which was published in Frontiers in Behavioral Neuroscience, noted that subjects responses varied based on strains. Both Drs. Cooper and Di Ciano say this only further supports the assertion that CBD-specific research in male and female subjects is necessary.

"I do think we're at a point now where there's a lot more attention given to this need, so I think that looking at the sex differences with cannabodial is really right around the corner," says Dr. Cooper. "You have to also just keep in mind that even though cannabidiol is everywhere right now—and one in seven, U.S. adults are using it—research is still in its infancy. So it's not surprising that there hasn't been much of a look into how males and females differ. But as research continues to grow in this area, I think that certainly looking at differences between men and women is going to be an obvious next step." 

For now, both Drs. Cooper and Di Ciano say you should consult with your primary care physician before starting any new treatment protocol to address anxiety, including using CBD. "Also because cannabidiol can interact with medications that people are already taking differently, that's another reason why it's important to have a conversation with their physician," says Dr. Cooper. 

Why researchers think fewer women participate in CBD studies

Despite more initiatives to include women in research, they are still being left out of newer studies on mental health and CBD. It's hard to say exactly why women are still underrepresented in CBD research, says Dr. Di Ciano. But she has a few guesses....

"In our own clinical research, we have noticed that it is much easier to recruit males than females," she says. "Males respond to advertisements more than females. The reasons for this are not entirely clear to us—this may be due to availability. For example, females have more childcare responsibilities and potentially less time to participate in clinical research. Getting a better understanding of why women seem less interested in participating in clinical trials would help us to develop strategies to better engage them."

Several organizations are currently advocating for including and recruiting more women in research. One is the Women in Medicine Summit, founded by Dr. Shikha Jain. “My hope is that when we move forward and realize more and more the fact that this discrepancy still exists,”  Dr. Jain previously told Well+Good. “That physicians will make a concerted effort and be intentional in including men and women [in clinical trials] equivalently.”

Aside from willingness to participate, part of why there's such a dearth of female subjects in clinical research is that there wasn't much of an emphasis placed on the gender in the past. "In general, it's not until very recently that researchers have seriously begun to understand or probe differences between male and female organisms in their scientific investigation," she says.

Even though Congress passed the NIH Revitalization Act, which requires women and minorities to be included in clinical research studies, in 1993, Dr. Cooper says she didn't really start to see a major shift in her field of study until about 10 years ago. 

Another reason sex-based research is becoming more and more important? "Females are being drawn to the medicinal cannabis market to help treat a range of indications," says Dr. Cooper. "We also know that there's an increase in CBD use during pregnancy. So understanding why women are using it during pregnancy and what are the outcomes associated with that use is also very important."

Right now, women make up 55 percent of CBD users, according to a cannabis industry report by Brightfield Group. 

Why gender needs to play a key role in the future of CBD mental health research

"Women suffer from anxiety, and also depression, much more than men," says Dr. Di Ciano. And not only are women more likely to experience anxiety in their lifetime, the symptoms can change throughout the different phases of life, including before and after menopause, during pregnancy, or after giving birth largely in part to hormonal shifts.

"By not studying women, we are doing them a disservice by not understanding the influence of female hormones on anxiety and its treatment. Clinical trials in general do not factor the phase of the menstrual cycle. Women need to be included in clinical trials through targeted campaigns to include them and the role of sex hormones needs to be studied and controlled," says Dr. Di Ciano.

In her own research, Dr. Di Ciano's begun studying how hormonal fluctuations and the menstrual cycle might influence CBD and cannabis use. "This research is still in the very early stages and the data is not available yet," she says. "We hope to have results in the next year or two, and also hope that the findings will generate new research avenues."

And hormonal shifts aren't the only areas that deserve attention. "Apart from sex differences in anxiety, an area that is often overlooked is gender. For example, we see in the current pandemic that women are shouldering more of the childcare responsibilities due to the stay-at-home orders that have shut our schools. These gender roles that place more of a burden on women are often overlooked, but they can influence the prevalence and severity of anxiety," says Dr. Di Ciano. "There is a real need for an understanding of the intersection of gender with the effects of cannabis, and CBD in particular."

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