Gender and sex differences shape how people use MDMA and how it affects them. Women often use MDMA to cope with negative emotions or self-medicate after traumatic life events, while men are more likely to start using due to peer pressure or sensation-seeking. Women report greater anxiety, adverse effects, and negative side effects from MDMA, and they face higher risks of sexually transmitted infections because of altered mental states and reduced condom use. Women may be more susceptible to hyponatremia but less vulnerable to MDMA-induced hyperthermia. Prenatal MDMA exposure may cause motor delays in infants. MDMA-assisted psychotherapy shows promise for treating PTSD, especially in female subgroups. More research is needed to develop tailored treatments.
A scoping review of 75 studies on psychedelics for substance use disorders found that most did not adequately account for sex or gender. Only 18 studies had sex-balanced samples, 46 underrepresented females, 9 included no females, and 5 did not report sex. Thirteen studies considered sex in their design, 11 conducted sex-based analyses of substance use outcomes, and only 5 acknowledged sex underrepresentation as a limitation. None addressed sex or gender in the discussion. The authors conclude that, given the recognized role of sex and gender in substance use disorder treatment, such explorations should be encouraged.