加拿大大麻合法化前后时期不育男性精液质量、激素水平和物质使用的时间趋势。
Temporal Trends in Semen Quality, Hormone Levels, and Substance Use Among Infertile Men in Pre- and Post-Cannabis Legalization Eras in Canada.
作者信息
Karavani Gilad, Bobrowski Adam, Lajkosz Katherine, Lau Susan, Lo Kirk C, Grober Ethan D, Krakowsky Yonah, Jarvi Keith
机构信息
Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada.
出版信息
Cannabis Cannabinoid Res. 2024 Dec;9(6):e1588-e1596. doi: 10.1089/can.2023.0164. Epub 2024 Jan 9.
The Cannabis Act (Bill C-45) was enacted in 2018, to legalize and regulate the use, production, and sale of nonmedical cannabis in Canada. While public health and safety implications of cannabis legalization have yet to be elucidated, the wide availability of cannabis necessitates health care providers to be knowledgeable about therapeutic potential and side effects of use. This study aimed to examine the temporal trends over two decades and the impact of the Cannabis Act in Canada, implemented in October 2018, on substance use, semen parameters, and testosterone levels of infertile men. We conducted a retrospective cohort study from a prospectively maintained database of a single infertility clinic. Demographic, fertility, and substance use history were correlated with semen and hormone assessments. Temporal trends in cannabis use and semen quality between 2001 and 2021 were investigated and compared between pre-cannabis legalization eras (PRCL) and post-cannabis legalization eras (POCL). Our cohort included 11,630 patients (9411 PRCL and 2230 POCL). Cannabis use increased by 8.4% per year (<0.001), while alcohol and tobacco consumption declined (0.8% and 1.5% per year, <0.05 and =0.004, respectively). Similar trends were noticed in the POCL, with higher rates of cannabis use (22.4% vs. 12.9%, <0.001) and decreased tobacco and alcohol intake (15.2% vs. 17.7%, =0.005 and 50.5% vs. 55.2%, <0.001, respectively) compared to the PRCL group. Semen concentration was lower in the POCL group (24.8±44.8 vs. 28.7±48.3 million/mL, =0.03). Testosterone did not differ between the cohorts. Comparison between cannabis users (=1715) and nonusers (=9924) demonstrated a slight increase in sperm motility (25.9%±15.3% vs. 23.9%±15.0%, =0.002) and decreased sperm concentration among users (27.6±53.5 vs. 23.9±15.0 million/mL, =0.03). A nearly 10% rise in cannabis use in the POCL era was observed among men being investigated for infertility. Our data suggest cannabis use may be associated with an increase in testosterone, slightly improved sperm motility, and decreased sperm concentration.
《大麻法案》（C-45法案）于2018年颁布，旨在使加拿大非医用大麻的使用、生产和销售合法化并加以规范。虽然大麻合法化对公众健康和安全的影响尚待阐明，但大麻的广泛可得性使得医疗保健提供者有必要了解其治疗潜力和使用的副作用。本研究旨在考察二十年间的时间趋势，以及2018年10月在加拿大实施的《大麻法案》对不育男性物质使用、精液参数和睾酮水平的影响。我们从一个前瞻性维护的单一不育诊所数据库中进行了一项回顾性队列研究。将人口统计学、生育和物质使用史与精液及激素评估进行关联。调查并比较了2001年至2021年间大麻使用和精液质量的时间趋势，以及大麻合法化前时代（PRCL）和大麻合法化后时代（POCL）的情况。我们的队列包括11630名患者（9411名PRCL患者和2230名POCL患者）。大麻使用量每年增加8.4%（<0.001），而酒精和烟草消费量下降（分别为每年0.8%和1.5%，<0.05和=0.004）。在POCL中也观察到了类似趋势，与PRCL组相比，大麻使用率更高（22.4%对12.9%，<0.001），烟草和酒精摄入量减少（分别为15.2%对17.7%，=0.005和50.5%对55.2%，<0.001）。POCL组的精液浓度较低（24.8±44.8对28.7±48.3百万/毫升，=0.03）。各队列之间睾酮水平无差异。大麻使用者（=1715）和非使用者（=9924）之间的比较显示，精子活力略有增加（25.9%±15.3%对23.9%±15.0%，=0.002），使用者的精子浓度降低（27.6±53.5对23.9±15.0百万/毫升，=0.03）。在接受不育调查的男性中，观察到POCL时代大麻使用量增加了近10%。我们的数据表明，大麻使用可能与睾酮增加、精子活力略有改善和精子浓度降低有关。
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