Gender differences and MDMA

At a societal level, drug use is considered a male dominated area. However, many other communities now use club drugs, with the latest General Population Survey showing increases in young females using MDMA and cocaine.

Females face distinctive issues when it comes to substance use, which are influenced by sex (differences based on biology) and gender (differences based on culturally defined roles for men and women given by society).

Different genders will experience the effects and harms associated with drugs in different ways which is an interesting area that needs further research.

See our update on biological influences and MDMA below.

Background

Findings from the Global Drug Survey in 2016 indicate that there had been a four-fold increase in British female clubbers reporting seeking emergency treatment after taking MDMA in the last three years – and that women are now two to three times more likely to seek emergency treatment than men.
There was increased attention in Europe on festival related deaths before the COVID-19 pandemic.
Deaths no are less likely to be due to contaminated products but relate to consuming too much MDMA due to the purity of products now available on the market. However, new substances such as cathinone type drugs are now being found in MDMA powder/crystals and pills.

Biological differences and MDMA

The evidence suggests that people appear to be more at risk of harm associated with MDMA due to hormonal differences but this area needs greater research.

There also needs to be greater research with inclusion of LGBTI+ communities to review their risk levels.

What we know so far:

Of the research to date, the studies we identified have focused on two definitions of 'female' and 'males' and their MDMA risk without consideration of other orientations and hormonal influences.
These studies state that "equal doses of MDMA per kilogram body weight produce stronger responses in these studies among female respondents". Further, they state that "females are more likely to experience more hallucinogen-like effects" based on their findings.
Hormones will increase the risk of developing the ecstasy-associated condition known as ‘hyponatremia’. What this means is that bodies will retain more water, which in some cases can lead to dangerous brain swelling.
The hormone Oestrogen, impairs cells’ ability to release water, meaning people are particularly at risk from this effect when using MDMA.
Hormones such as oestrogen may increase the risks at different times in a persons life such as during a person’s menstrual cycle and so they should take less MDMA than usual during these times.This may vary for others on hormone treatments and this area requires further investiation regarding hormones influnece on MDMA risk.
As a rough guide an average dose for MDMA pill through swallowing is around 70-80mg (for an average person of average build). This amount would be less if snorting. Therefore those who may weigh less than their counterparts may need to consume less. However, MDMA pills are currently increasing in strength and may contain dangerous amounts of MDMA ranging from 120mg – 300mg of MDMA. You can never trust the contents or potency

Water retention and MDMA

MDMA can affect the body’s perception of how hydrated you are. What this means is that you can feel thirsty but it also can stop you also being able to urinate.
In some cases, this can make people feel that they need to drink more water than their body actually needs.
Too much water and lack of urination can make your blood become overly diluted.
Over dilution of the blood impacts on the balance of electrolytes in your brain which are essential for it to work
Drinking too much water can lead to an MDMA relate condition called ‘hyponatremia’ which can be fatal.
For those who use MDMA, hydration and remaining cool is important but it is recommended that people don’t consume over one pint of water an hour.

More Information

Get information about the effects and risks of MDMA here
Get harm reduction information for people who use MDMA here
In cases of MDMA emergency, it is important to get medical help as soon as possible on 112/999 or in a venue. See our overdose prevention information here.
Sex Differences in the Effects of MDMA (Ecstasy) on Plasma Copeptin in Healthy Subjects
Gender differences in the subjective effects of MDMA
MDMA may pose greater danger to women than men, say scientists