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Harm reduction tips for women using recreational drugs
Courtesy of Rusopplysningen, a drug information project by Safer Drug Policies.
Photos: Pexels.com.
While there will always be vast differences at the individual level in how various recreational drugs affect people, there are also some group level trends that align with biological sex differences. Sadly, the research on these differences has historically been sparse, making it difficult to give much sex-specific harm reduction advice on firm ground, but this article outlines three areas that women might want to pay particular attention to.
(Most of the available research on women and drug use is based on a binary understanding of gender and primarily involves cisgender participants. Where specific knowledge exists about transfeminine people or trans women on hormone therapy, we have highlighted this in the text.)
(Most of the available research on women and drug use is based on a binary understanding of gender and primarily involves cisgender participants. Where specific knowledge exists about transfeminine people or trans women on hormone therapy, we have highlighted this in the text.)
"Women tend to need less of a drug in order to achieve the same effects."
Dose carefully, especially if using tablets
On average, women have a lower body mass than men and a different body composition. Women therefore tend to need less of a drug in order to achieve the same effects. Since the majority of people who use illicit drugs are male, however, and most of the medical research on both licit and illicit drugs has been carried out on male test subjects, the dosages commonly recommended and considered safe tend to be more suited to male users.
On average, women have a lower body mass than men and a different body composition. Women therefore tend to need less of a drug in order to achieve the same effects. Since the majority of people who use illicit drugs are male, however, and most of the medical research on both licit and illicit drugs has been carried out on male test subjects, the dosages commonly recommended and considered safe tend to be more suited to male users.
Photo: Mikhail Nilov / Pexel.com
This is particularly relevant when using illicit drugs that are sold pre-dosed, like ecstasy, illicit benzodiazepine or opioid tablets. Today’s ecstasy tablets will often contain more than 200 milligrams of MDMA, which is excessive even for male users. Some tablets may even contain more than 300 milligrams, which is three times the amount that one will typically need in order to achieve desirable effects with minimal side effects – and about four times a reasonably safe starting dose for someone who has never tried MDMA before.
When using MDMA female users should be particularly mindful of their fluid and electrolyte intake, preferably opting for electrolyte drinks over water
Be sure to get enough electrolytes
When using stimulants, and especially MDMA-like stimulants, your body’s electrolyte balance can more easily be disrupted by fluid intake. The most dangerous consequence of this is hyponatremia, aka. water poisoning, which can cause swelling of the brain and cardiac arrhythmias that can be fatal if not addressed.
Hyponatremia is an imbalance between the amount of water and the amount of salt in the body, and it typically occurs when someone drinks a large amount of unsalted fluids without having anything salty on the side. It also occurs more easily if someone has already lost a lot of salt through heavy sweating, or if they do not urinate frequently enough – both of which can often occur when using stimulants. Additionally, MDMA has been shown to lower blood sodium levels, thus lowering the threshold for hyponatremia.
While female users seem to be somewhat less susceptible to MDMA-induced hyperthermia (overheating) than male users, they are more susceptible to MDMA-induced hyponatremia. While hyperthermia is the more well-known of these effects, more MDMA-related fatalities have been associated with hyponatremia, and the deceased have often been female.
Female users should therefore be particularly mindful of their fluid and electrolyte intake when using serotonergic stimulants (like Amphetamines, cocaine, LSD, MDMA), preferably opting for electrolyte drinks over water. Powerade works, but the effervescent tablets from the pharmacy are better. Water is also OK when eating salted foot (e.g. chips), but eating can be a chore on stimulants.
Female users should also look out for typical symptoms of hyponatremia, like confusion and lethargy combined with a headache. Since these symptoms can be difficult to recognize in yourself if you are sufficiently confused, it’s a good idea to ensure that your friends are also able to spot them. In severe cases, hyponatremia can lead to a coma. If someone is unconscious and unresponsive, it’s usually a good idea to call an ambulance.
When using stimulants, and especially MDMA-like stimulants, your body’s electrolyte balance can more easily be disrupted by fluid intake. The most dangerous consequence of this is hyponatremia, aka. water poisoning, which can cause swelling of the brain and cardiac arrhythmias that can be fatal if not addressed.
Hyponatremia is an imbalance between the amount of water and the amount of salt in the body, and it typically occurs when someone drinks a large amount of unsalted fluids without having anything salty on the side. It also occurs more easily if someone has already lost a lot of salt through heavy sweating, or if they do not urinate frequently enough – both of which can often occur when using stimulants. Additionally, MDMA has been shown to lower blood sodium levels, thus lowering the threshold for hyponatremia.
While female users seem to be somewhat less susceptible to MDMA-induced hyperthermia (overheating) than male users, they are more susceptible to MDMA-induced hyponatremia. While hyperthermia is the more well-known of these effects, more MDMA-related fatalities have been associated with hyponatremia, and the deceased have often been female.
Female users should therefore be particularly mindful of their fluid and electrolyte intake when using serotonergic stimulants (like Amphetamines, cocaine, LSD, MDMA), preferably opting for electrolyte drinks over water. Powerade works, but the effervescent tablets from the pharmacy are better. Water is also OK when eating salted foot (e.g. chips), but eating can be a chore on stimulants.
Female users should also look out for typical symptoms of hyponatremia, like confusion and lethargy combined with a headache. Since these symptoms can be difficult to recognize in yourself if you are sufficiently confused, it’s a good idea to ensure that your friends are also able to spot them. In severe cases, hyponatremia can lead to a coma. If someone is unconscious and unresponsive, it’s usually a good idea to call an ambulance.
"Whether cis- or trans, female sex hormones can affect how you experience the drugs effects"
Be mindfull of hormonal changes
Whether someone is a cis woman with normal ovarian function, a cis women who uses hormonal contraceptives, or a cis or trans woman who is receiving estrogen therapy, female sex hormones can modulate the rewarding effects they experience from recreational drugs.
The most important effect in this regard is probably the apparent ability of estradiol (an estrogen whose levels increase significantly in the late follicular phase of the estrus cycle) to enhance the rewarding effects of drugs. Research findings have suggested such an effect for a variety of drugs ranging from simulants to opioids, alcohol, and possibly cannabis.
Since some evidence suggests that this enhanced reward increases the risk of developing dependence, it might be wise to avoid the most addictive drugs in the days near ovulation. Similarly, cis or trans women receiving estrogen therapy should be mindful of the possibility of enhanced drug reward effects when starting hormone therapy, when transitioning from one medication to another, or when increasing the dose.
Whether someone is a cis woman with normal ovarian function, a cis women who uses hormonal contraceptives, or a cis or trans woman who is receiving estrogen therapy, female sex hormones can modulate the rewarding effects they experience from recreational drugs.
The most important effect in this regard is probably the apparent ability of estradiol (an estrogen whose levels increase significantly in the late follicular phase of the estrus cycle) to enhance the rewarding effects of drugs. Research findings have suggested such an effect for a variety of drugs ranging from simulants to opioids, alcohol, and possibly cannabis.
Since some evidence suggests that this enhanced reward increases the risk of developing dependence, it might be wise to avoid the most addictive drugs in the days near ovulation. Similarly, cis or trans women receiving estrogen therapy should be mindful of the possibility of enhanced drug reward effects when starting hormone therapy, when transitioning from one medication to another, or when increasing the dose.
Photo: Lena Glukhova/Pexels.com
In the case of alcohol, increased estradiol levels in the late follicular phase also seem to enhance the drug’s disinhibiting effects. (It is unclear whether this also occurs with other disinhibiting drugs, but this might be assumed.) It could therefore be wise to be mindful not just of alcohol intake levels in this phase of the estrus cycle, but also of what situations and settings the drinking is happening in, and whether you are with people you can trust.
Conversely, progesterone seems to dampen the rewarding effects of many recreational drugs. This suggests that common hormonal contraceptives may offer some degree of protection against the development of dependence. However, it also suggests that addictive drugs should be used with great caution when quitting progesterone-based contraceptives.
Conversely, progesterone seems to dampen the rewarding effects of many recreational drugs. This suggests that common hormonal contraceptives may offer some degree of protection against the development of dependence. However, it also suggests that addictive drugs should be used with great caution when quitting progesterone-based contraceptives.
If you have questions about women and recreational drug-use, do not hesitate to contact Chemfriendly. You can talk to both peers and professionals. Contact us via e-mail, our Facebook- or Instagram profile, or via our profile on Gaysir.no.
You might also want to read this article about Women, Sex and Drugs (Norwegian): Kvinner og chemsex.
Publisert 10.6.2025.