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Additionally, most studies in people do not have behavioral measures from before MDMA use started, making it difficult to rule out pre-existing differences or common underlying risk factors across groups that are separate from MDMA use. 83,106,107 Factors such as gender, dosage, frequency and intensity of use, age at which use began, and the use of other drugs, as well as genetic and environmental factors all may play a role in some of the cognitive deficits associated with MDMA use and should be taken into consideration when studying the effects of MDMA in humans.