This article was originally written by Adryan Corcione. Additional research and writing about cannabis and gender-affirming hormone therapy/hormone replacement therapy (GAHT/HRT) was provided by Nina Kossoff. The current version was edited for clarity by Katie Taibl. Quotes have been edited for clarity and length.

Cannabis is a plant many transgender people use to support their mental health. We recognize many in our community navigate substance use disorders and that cannabis use is not for everyone. However, some folks find cannabis helps them feel more comfortable in their own skin. Many LGBTQ adults, young and old, find improved mental health with cannabis use. In this article, we interview gender-diverse folks about their relationship with cannabis, gender identity, and mental well-being.

Over a decade since the first states (Colorado and Washington) legalized recreational marijuana use, cannabis is more culturally relevant than ever in the United States. As of April 2023, 21 U.S. states have legalized marijuana for adult use. Over two-thirds of Americans support marijuana legalization, and over 90% support the medical use of marijuana.

In 2022, the U.S. House of Representatives passed the Marijuana Opportunity and Investment (M.O.R.E.) Act, which would encourage more states to legalize cannabis. It proposed removing marijuana from the list of scheduled substances under the Controlled Substances Act. Though this wouldn’t free all cannabis prisoners, it would greatly reform the criminal justice system—a punitive institution that criminalizes mostly Black and Brown people—as we know it.

In 2021, $3.7 billion in tax revenue was generated from legal cannabis sales. The queer history of the medical marijuana movement reveals the LGBTQ’s community influence on legalization.

Marijuana has been used as a healing substance for decades in the LGBTQ community. For some transgender people, it can play a role in easing dysphoria. It may also enhance gender euphoria. This may be why gender minorities reported less-risky patterns of marijuana use compared to cisgender young adults.

Cannabis use and consumption in the transgender, non-binary, and gender-expansive community

Little spotlight has been made on transgender, nonbinary, and other gender non-conforming people concerning the use of cannabis. This may be related to the cis-heteronormative dominant media.

As someone with a background in drug journalism and the cannabis industry, almost every queer or transgender person I know consumes cannabis or did at one point. I’ve also noticed that trans people aren’t typically invited to the conversation around cannabinoid use. On occasion, sexual and gender minorities are respondents; but they’re rarely interviewed by a trans person themselves.

Some trans people use cannabis to cope with the feelings of gender dysphoria and find their use of the substance changes post-transition. I interviewed seven trans and nonbinary people about why they love weed, how cannabis helps alleviate gender dysphoria, and how it brings LGBTQ+ people together.

Why do you love cannabis?

“The stoners I have met in my life have been some of the most creative, caring, kind-hearted people I have ever met. Now, weed is my litmus test to see if I will vibe with someone. Smoking a joint with friends is a true bonding experience for me!” Drïan Juarez (she/they/elle)

“The mood for me is just the number one thing… depression is something I’ve suffered from at an early age, PTSD, obviously growing up queer… so cannabis is a great way not to make myself happy but at least help myself get to the road of choosing happiness. I think cannabis has made me a more present being. It’s made me more aware of my surroundings and myself. I think it has made me more confident. Cannabis helped give me the courage to go out and wear what I wanted to wear and be myself.” Laganja Estranja (she/her)

“I like how [weed] stimulates my appetite, and I like how [weed] makes it more interesting to read or take in information or engage with media. Often, it makes me more curious and helps me learn and remember things. It makes music more enjoyable, makes sex better, and in general makes everything more interesting and engaging.” Nervewing (they/them)

“I smoke weed like people used to smoke cigarettes. There's always a reason to smoke, whether celebrating good times or managing the bad, celebrating a joyous occasion, or just doing something when nothing else is going on. Weed can be whatever you want it to be.” Kurt Suchman (they/them)

“Weed can transform a boring night indoors watching television into a fun, goofy time watching nature documentaries blazed out of your mind. It's also such a (mostly) well-received social agent. Not everyone can drink alcohol, but most people tend to smoke. There's nothing more uniting than being at the beach and striking up a conversation with complete strangers over a joint.” Frank Vidal (he/they)

How has cannabis helped you forge a community?

“One of my fondest memories was when my friend's partner passed away from HIV complications. We were sitting in her living room after the service feeling pretty low, and my friend started rolling a blunt and passing it around. Before you knew it, we were all sharing stories and laughing. What I loved the most was that my friend's mother, whom I met for the first time, was there joining in. I just thought about how amazing that was and how much I would love to share a joint smoking session with my mother and others in my family! How incredible it would be if we smoked weed together at a family gathering instead of drinking alcohol!” Drïan Juarez (she/they/elle)

“It has helped me get through the toughest of times when I didn’t want to exist in my body the way it was and dreamt of said euphoria. It momentarily provided me with respite from the physical dissonance I experienced.” Anonymous

“Whenever anybody came over to my old house in Philly, I would immediately offer them a dab, or if they wanted to roll up, or if they wanted any edible gummies, etc. It was like a good-faith peace offering to everybody, all the time. If you came over, I was gonna take care of you and make sure you had everything you needed to feel good and comfortable.” Frank Vidal (he/they)

“[Weed is] a wonderful way to break the ice and start a conversation.” Nervewing (they/them)

“There’s just something that really encourages bonding about hanging out and smoking–it encourages conversation, connection, and warmth. When you combine this with shared experiences of queerness and the incredible art and humor and personality that so many queer people bring to the table, I think it can be an incredible tool for community building.” Mercer C. (he/him)

Has your relationship with cannabis changed pre-transition versus post-gender transition? If so, how?

“I think I’m smoking less because I’m not running away from my truth, and I don’t need to overmedicate to hide from myself. Now that I’m more comfortable, I’m finding a more relaxed usage of cannabis, whereas before, I definitely think I relied on it and needed it every second of every day. Now I’m feeling like I’m able to consume at a much slower rate.” Laganja Estranja (she/her)

“I would say that it affirms my gender in that it liberates me from the social pressures to conform to female stereotypes and define myself in a way that feels good to me. As someone who transitioned within raver culture, I began exploring weed and my female identity in concert and within the electronic music scene, warehouse parties, and outdoor parties, and that was more about creating yourself as art for you and others to enjoy rather than passing and weed definitely felt like a catalyst for my creativity!” Drïan Juarez (she/they/elle)

“Back when I gave a shit about being perceived as ladylike or feminine, I would hold back on, say, trying not to cough. Or appearing dainty when I rolled and licked a joint. Now I take massive bong rips and don't care how hard a dab made me cough. I think leaning into the stoner identity was also coupled with me leaning into my more masculine expressions.” Frank Vidal (he/they)

“Weed used to be a suppressant for me that I would use to cope, ultimately to dull other feelings. Now it feels more like I smoke to embrace more, myself included.” Kurt Suchman (they/them)

“The main difference in my relationship with weed pre and post-transition is the feeling of shame. When I was pre-testosterone, I held a lot of guilt and shame around smoking weed. I was experiencing a lot of issues with addiction around the time and felt pressure from my friends and family and the court system to get sober, and I simply couldn’t. In reflection, I think a lot of that shame and addiction cycle was based on the loneliness and anger, and alienation of my trans experience before I had the words for or understanding of it. Once I began my transition, my relationship with weed completely changed. It no longer felt like a source of shame or an issue in my life. I could understand more the reality of why I smoked weed, what it did for me, and whether the ways I was engaging with it were healthy or not for me.” Mercer C. (he/him)

“I experience much more gender euphoria now, so there’s less need to ‘escape’ the discomfort. Now I mostly smoke to lighten my mood, mellow out and go to sleep.” Anonymous

What's the most rewarding thing about cannabis?

“I have a lot of issues with depression and anxiety that make me feel out of touch with my body, but weed puts me back into it. Feeling more in tune with my body gives me a better sense of how I see myself and how I want to look … Just smoking and watching movies or listening to music feels affirming to me. Cannabis has a great way of silencing the outside world and letting me explore my inner self, letting my mind wander and imagine my body outside the societal expectation of it.” Kurt Suchman (they/them)

“It brings me closer to myself. The feeling of acceptance is the most powerful thing I get from cannabis.” Laganja Estranja (she/her)

“Weed has helped me explore my understanding of my gender and gender presentation. I experience a lot of fear and anxiety about going out in public or being on social media wearing makeup or what’s traditionally considered ‘feminine’ clothes in Western society. [This is due to] safety reasons and anxiety about the people around me not respecting my true gender and pronouns…or questioning the validity of my trans experience. It’s just a lot easier for me to wear a skirt to the club if I smoke beforehand. Allowing myself the space to explore my gender presentation separately from my gender identity and people’s perception of it also helped me reflect more deeply on my own understanding of my gender identity without feeling influenced by the things I enjoy or like to wear and how those things are gendered in our society.” Mercer C. (he/him)

Important info for those on gender-affirming hormone therapy/hormone replacement therapy (GAHT/HRT)

Since the body is processing multiple things at once—tetrahydrocannabinol (THC) and/or cannabidiol (CBD) as well as hormones—we’ve gotten questions about whether there’s any interaction or interference between cannabis and GAHT specifically. Here are the two most frequently asked questions.

Does cannabis interact with gender-affirming hormone therapy (GAHT)?

While the short answer is no, the long answer is that more information is needed. Most of what we know is based on animal studies. Little research has been done with humans, let alone transgender or gender-diverse people. A 2018 Merry Jane article dives deeper into individuals’ self-reported experiences with changing hormone levels and their reactions to cannabis.

Professor and researcher Dr. Rebecca Craft also studies interactions between cannabis and hormones in rats. Dr. Craft is approved by the U.S. Drug Enforcement Administration to work with Schedule I drugs such as cannabis. Her findings showed estrogen (estradiol) can increase THC sensitivity (and tolerance).

What’s the deal with cannabis, fertility, and GAHT?

For people born with sperm-producing organs, studies correlate a decrease in sperm count with weekly cannabis use. One 2015 study looked at 1,215 young Danish people with penises aged between 18 and 28 years. The study found that regular cannabis smoking (more than once a week) was associated with 28% lower sperm concentration and a 29% lower total sperm count. People on estrogen may already see a decrease in sperm production, which makes this a consideration for those interested in family planning.

For people born with egg-producing organs, fewer studies are available. A 2021 study references how THC disturbs ovulation. High levels of cannabinoids have been shown to suppress reproductive hormones. Cannabinoids in marijuana may disrupt the Endocannabinoid System (ECS), which is responsible for successful reproduction. Though human studies indicate that moderate to heavy marijuana substance use is linked to infertility, larger studies have not demonstrated a “prolonged time to pregnancy” in those who use the substance.

Testosterone also affects the way existing hormones, specifically those in charge of menstruation and ovulation, function within bodies in ways that can make someone less fertile.

 

At FOLX, we recognize the power of harm reduction; not everyone needs to be sober to live their truth unless sobriety is desirable and accessible to you. If you’re a FOLX member and have questions about cannabis or other drugs and how they interact with hormone replacement therapy, schedule a time with your clinician. If you’re not a FOLX member, contact member support with any questions—we’re happy to help!

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FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include expert, gender-affirming virtual health care, gender-affirming hormone therapy (sometimes known as HRT or hormone replacement therapy), mental health care, sexual health care, and more. We offer memberships for testosterone and estrogen, sexual health products like PrEP, and peer support groups. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQ-friendly healthcare with FOLX. FOLX Health is for everybody and every body in the LGBTQIA+ community. You deserve to feel fabulous. To become a FOLX member, click here.