Dr. Sarah Hill: What the pill does to attraction and mood

The pill suppresses ovulation by shutting down the brain–ovary communication and replacing a woman’s natural cyclic hormones with a flat, synthetic progestin (and sometimes low-dose estrogen). Hill emphasizes that hormones are core inputs the brain uses to construct mood, motivation, attraction, stress reactivity, and energy. Changing those signals effectively changes the “version” of a woman that her brain creates—her libido, interests, and even sense of aliveness can shift.

By flattening estrogen’s mid-cycle surge and sharply reducing free testosterone (via increased sex hormone binding globulin), many women experience lower libido and less variation in desire. Research shows pill users tend to prefer less masculinized, lower-testosterone-looking men compared to naturally cycling women. Longitudinal data on married couples suggest that when women come off the pill, attraction to their partner can increase or decrease depending on his baseline attractiveness—more attractive partners become more desired; less attractive partners may become less appealing and less sexually satisfying.

Hill cites large Danish data showing women on the pill were ~50% more likely to be diagnosed with depression within six months, and about twice as likely to have attempted suicide as naturally cycling women. In adolescents, whose brains are still remodeling under the influence of natural sex hormones, suppressing those hormones with synthetics may alter developmental trajectories in ways we don’t yet fully understand. She stresses that these mental-health risks are rarely highlighted in clinical settings, leaving girls and parents without true informed consent.

Naturally, short, sharp spikes of cortisol to acute stress are adaptive; they help regulate emotion, immunity, and recovery. Women on hormonal birth control often show a flattened or absent cortisol response to stress—similar to patterns seen in people with trauma and PTSD—suggesting dysregulated stress systems. This may partly underlie higher rates of mood disorders and altered immune and inflammatory responses in pill users.

Women across cultures tend to prefer and marry men who are older, higher status, and better resourced—“mating up” in education and income. As women now outnumber men in universities and increasingly out-earn them, the pool of men who meet these preferences shrinks. Hill notes data showing many educated women opt to remain single rather than “marry down”, contributing to reduced marriage rates, later sex, more long-term singleness, and fewer children despite widespread availability of contraception.