Testosterone Enanthate and Cannabis Interaction Profile

At a glance

• Label status / Cannabis is not named in the enanthate drug interactions section [1]
• Label interactions / Oral anticoagulants, antidiabetic drugs and insulin, ACTH and corticosteroids, oxyphenbutazone [1]
• Blood pressure / FDA says ABPM studies confirmed BP increases with all testosterone products [2]
• Venous clots / DVT and PE reported; label says discontinue if suspected [1]
• Red blood cells / Intramuscular enanthate/cypionate raised mean hematocrit 4.0% vs placebo in a meta-analysis [3]
• Cannabis hormone data / One four-man study found marijuana smoking lowered LH; testosterone changes were not significant [4]
• Bottom line / Label monitoring and warnings still apply.

Does the testosterone enanthate label list cannabis?

No. The drug interactions section of the testosterone enanthate prescribing information names oral anticoagulants, antidiabetic drugs and insulin, ACTH and corticosteroids, and oxyphenbutazone [1]. Cannabis is not among them, so the label gives no cannabis-specific dose adjustment or monitoring. Its absence from the label does not mean the combination has been shown safe.

Is there any study of testosterone enanthate plus cannabis?

No study that gave testosterone enanthate and cannabis together and measured hormone levels, blood pressure, hematocrit or clinical outcomes is available to cite. The closest human hormone data are indirect. In a randomized crossover study of four healthy men, smoking marijuana significantly lowered plasma LH and raised cortisol; testosterone and free testosterone fell but not significantly, and the hormone effects stayed within normal basal ranges [4]. The enanthate label says exogenous androgens inhibit pituitary LH through feedback [1]. A systematic review of cannabis and male fertility found lowered LH and unchanged FSH, with testosterone effects inconclusive [5].

What does the label warn about that matters here?

Testosterone enanthate can increase blood pressure, and the label says testosterone products are not recommended for men with uncontrolled hypertension [1]. FDA says ambulatory blood pressure studies confirmed a blood pressure increase with all testosterone products, class-wide [2]. The label also lists venous thromboembolism, including DVT and PE, and says to discontinue testosterone enanthate and start a workup if a VTE is suspected [1]. Polycythemia is listed as an adverse reaction [1]. A network meta-analysis of 29 placebo-controlled trials found intramuscular testosterone enanthate/cypionate raised mean hematocrit by 4.0% versus placebo (95% CI 2.9 to 5.1) [3]. The enanthate label also still carries an older paragraph saying studies have been inconclusive for major adverse cardiovascular events, and it does not mention TRAVERSE [1].

Does cannabis change cardiovascular risk?

Cannabis has its own cardiovascular questions. The American Heart Association's 2020 scientific statement on cannabis and cardiovascular health says many of the concerning health implications of cannabis include cardiovascular diseases, although they may be mediated by the delivery method [6]. The cardiovascular trial often cited for testosterone, TRAVERSE, enrolled 5,246 men aged 45 to 80 with hypogonadism and tested daily 1.62% testosterone gel, not an injection; major adverse cardiovascular events occurred in 7.0% on testosterone gel and 7.3% on placebo, meeting noninferiority [7].

What about fertility?

The enanthate label says large doses of exogenous androgens may suppress sperm production through FSH feedback inhibition, and oligospermia may occur at high dosages [1]. A systematic review of cannabis and male fertility found the strongest evidence for effects on semen parameters, with research supporting reduced sperm count and concentration, abnormal morphology, reduced motility and viability [5]. An observational study of 662 subfertile men found men who had ever smoked marijuana had higher sperm concentration and lower FSH than never-smokers; current and past smokers did not differ [8].

Frequently asked questions

›Does testosterone enanthate interact with cannabis?

The enanthate label's drug interactions section lists oral anticoagulants, antidiabetic drugs and insulin, ACTH and corticosteroids, and oxyphenbutazone, not cannabis [1]. The label also warns about blood pressure, venous thromboembolism and polycythemia [1][2].

›Does cannabis lower testosterone on testosterone enanthate?

No study has measured this. Injected enanthate supplies testosterone, and the label says exogenous androgens inhibit pituitary LH through feedback [1]. A four-man study found marijuana smoking lowered LH, while testosterone and free testosterone changes were not significant [4].

›Does cannabis affect fertility with testosterone enanthate?

The enanthate label says large doses of exogenous androgens may suppress sperm production through FSH feedback and lists oligospermia at high doses [1]. A systematic review found cannabis may reduce sperm count, concentration, motility and viability [5].

›What does the label say about blood pressure?

The label says testosterone can increase blood pressure, that blood pressure should be monitored periodically, and that products are not recommended for uncontrolled hypertension [1]. FDA says ABPM studies confirmed increases with all testosterone products [2].

›Is testosterone enanthate a controlled substance?

Yes. Testosterone enanthate contains testosterone, a Schedule III controlled substance under the Controlled Substances Act [1].

›What cardiovascular trial was done with testosterone?

TRAVERSE enrolled 5,246 men and tested daily 1.62% testosterone gel, not an injection; major adverse cardiovascular events occurred in 7.0% on testosterone gel and 7.3% on placebo, meeting noninferiority [7].

References

1. U.S. National Library of Medicine, DailyMed. Testosterone enanthate injection USP intramuscular, Hikma prescribing information. Testosterone enanthate injection USP intramuscular, Hikma label
2. FDA issues class-wide labeling changes for testosterone products | FDA. FDA issues class-wide labeling changes for testosterone products | FDA
3. Nackeeran S, Kohn T, Gonzalez D, White J, Ory J, Ramasamy R. The Effect of Route of Testosterone on Changes in Hematocrit: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Trials. J Urol. 2022;207(1):44-51. The Effect of Route of Testosterone on Changes in Hematocrit: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Trials
4. Cone EJ, Johnson RE, Moore JD, Roache JD. Acute effects of smoking marijuana on hormones, subjective effects and performance in male human subjects. Pharmacol Biochem Behav. 1986;24(6):1749-54. Acute effects of smoking marijuana on hormones, subjective effects and performance in male human subjects
5. Payne KS, Mazur DJ, Hotaling JM, Pastuszak AW. Cannabis and Male Fertility: A Systematic Review. J Urol. 2019;202(4):674-681. Cannabis and Male Fertility: A Systematic Review
6. Page RL, Allen LA, Kloner RA, Carriker CR, Martel C, Morris AA, et al. Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2020;142(10):e131-e152. Medical Marijuana, Recreational Cannabis, and Cardiovascular Health: A Scientific Statement From the American Heart Association
7. Lincoff AM, Bhasin S, Flevaris P, Mitchell LM, Basaria S, Boden WE, et al. Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med. 2023;389(2):107-117. Cardiovascular Safety of Testosterone-Replacement Therapy
8. Nassan FL, Arvizu M, Mínguez-Alarcón L, Williams PL, Attaman J, Petrozza J, et al. Marijuana smoking and markers of testicular function among men from a fertility centre. Hum Reprod. 2019;34(4):715-723. Marijuana smoking and markers of testicular function among men from a fertility centre