Translated from our German original by AI. The German text was researched, written, and edited by the Psychedelia Foundation team and remains the authoritative version.
A narrative review published in the journal Molecular Psychiatry examines what role female sex hormones could play in the effects and tolerability of psychedelics. The focus is on estradiol and progesterone in particular, along with hormonal changes during the menstrual cycle and menopause.
The authors conclude that hormonal status could represent a so far little considered source of individual differences in psychedelic experiences. Sex hormones influence the serotonergic system and the 5-HT2A receptors, through which classic psychedelics such as LSD and psilocybin produce a substantial part of their acute effect. Studies using PET and SPECT, as well as research on platelets, show that the availability or binding of these receptors can change in connection with hormonal changes.
Interactions are also conceivable at the pharmacokinetic level. Hormones can affect gastrointestinal function and the activity of CYP enzymes involved in the metabolism of LSD and psilocin, among other processes. Absorption, onset of effect, and drug exposure could change as a result. Direct studies demonstrating such effects with psychedelics across different hormonal phases in humans are still lacking, however.
The authors also consider it possible that subjective effects and tolerability in menstruating women could differ depending on the phase of the cycle. The early to mid follicular phase and the early luteal phase are discussed as possible phases of heightened sensitivity. This assumption, too, has not been confirmed by controlled clinical studies so far.
What the review offers, then, is above all a research framework rather than concrete recommendations for the use of psychedelics. Future studies should systematically account for cycle phase, menopausal status, hormonal contraception and hormone replacement therapy, and actual estradiol and progesterone levels.
The central message of the work is therefore that female hormonal status could be a relevant factor in the individual effects and tolerability of psychedelics. How large this influence actually is, and whether consequences for the timing or dosing of a psychedelic treatment follow from it, will first have to be settled by clinical research.
