Health characteristics of recreationally active female cannabidiol users: a real-world cross-sectional study

Cannabidiol (CBD) use has increased substantially in the United States alongside expanding legalization of cannabis and hemp-derived products. CBD is widely marketed for recovery, sleep, stress reduction, and overall well-being, yet evidence supporting these claims in healthy, physically active populations remains limited and mixed. Most controlled trials have been conducted in predominantly male cohorts, and emerging data suggest potential sex differences in CBD pharmacokinetics, underscoring the need to characterize female users.

This cross-sectional study examined behavioral and physiologic health correlates of real-world CBD use among recreationally active women aged 18-40 years. Participants completed validated assessments of physical activity (IPAQ), dietary patterns (PrimeScreen), sleep quality (PSQI), mental health (SFMHC), quality of life (QOL), and pain (VAP); a subset completed a 50-marker fasting blood panel. Current CBD users were compared to non-users (past and never users combined).

In the survey-only cohort (n = 149; 78 current users), CBD users reported significantly lower total MET-minutes (6,627 ± 5,344 vs. 11,301 ± 9,805; p < 0.01), shorter sleep duration (p < 0.001), and lower quality of life measures (p < 0.01). Mental health scores were lower but not statistically significant. Dietary quality was slightly higher among users (p < 0.01), though tobacco use was greater (p = 0.04). Post-exercise pain did not differ. In the biomarker subcohort (n = 20), non-users demonstrated higher basophils (p = 0.02), sex hormone-binding globulin (p = 0.04), and testosterone (p < 0.01), and lower thyroid-stimulating hormone (p = 0.05), with most values within reference ranges.

CBD use clustered with distinct behavioral and psychosocial characteristics, warranting longitudinal, sex-specific investigation.