The Diary of a CEODr. Sarah Hill: What the pill does to attraction and mood
An evolutionary psychologist shows how the pill rewires hormones: blunting desire, reshaping attraction, and shifting partner choice in subtle ways.
CHAPTERS
- 0:00 – 4:00
Pill, Partners, And Attraction Shocks
Hill opens with striking research: when women come off hormonal birth control, their attraction to their partner can markedly change depending on his attractiveness. This frames the central thesis that the pill reshapes women’s desires, relationships, and, by extension, society.
- •Study: women who met partners on the pill and later stopped showed increased attraction if their partner was attractive, decreased if he was less attractive.
- •Sexual satisfaction tracked the same pattern, indicating real relational stakes.
- •Host and Hill position this as both fascinating and unsettling for couples unaware of these dynamics.
- 4:00 – 13:00
Hill’s Mission: Making Women Understand Themselves
Hill explains her overarching mission: to generate and communicate science that helps women understand their own bodies and minds, rather than seeing themselves through male-based medical models. She stresses that most biomedical research has historically been done on men.
- •Medicine and physiology have been normed on male bodies and brains.
- •Hill wants women to be understood as themselves, not as “malfunctioning males.”
- •She insists the conversation is for everyone: women, partners, and anyone who loves women.
- •The host notes her work also helps men understand their own hormones and mating psychology.
- 13:00 – 23:00
How The Pill Enabled Female Independence—And Its Hidden Costs
They acknowledge the pill as the most transformative technology for female autonomy, enabling education, careers, and long-term planning, while unpacking downstream social shifts and unintended consequences that we’re only now grappling with.
- •The pill allowed women to reliably avoid pregnancy and make long-range plans.
- •Female representation in higher education has surged; many classrooms are majority women.
- •Positive downstream effects: more degrees, higher female earnings, greater independence.
- •Hill argues we’ve ignored the psychological and relational side effects in the rush to celebrate the benefits.
- 23:00 – 35:00
Hypergamy, Education, And The Emerging Mating Crisis
Hill outlines female hypergamy—women’s preference for men with equal or higher status and resources—and how the education gap (more educated women than men) is creating a smaller pool of “acceptable” long-term partners for many women.
- •Women cross-culturally prefer men who are older, better educated, and higher earning.
- •In the US, women are now more likely than men to be college-educated.
- •Educated women increasingly face a narrow mate pool and often choose singleness over “marrying down.”
- •Sex and dating are trending downward; more young people are virgins at graduation.
- 35:00 – 46:00
Why Women Don’t Just Date Down: Evolutionary Logic
Hill explains why, despite modern female earning power, many women still resist dating men with fewer resources. She roots this in ancestral dependence on male provisioning during pregnancy and childcare, which baked resource-prioritizing preferences into female psychology.
- •Historically, frequent pregnancy and childcare made women dependent on male provisioning and protection.
- •Women who preferred resourceful, investing men left more surviving offspring, so that preference spread.
- •These evolved preferences persist even though modern women can earn their own resources.
- •She contrasts evolutionary explanations with simplistic “patriarchy-only” narratives.
- 46:00 – 56:00
Patriarchy, Resources, And Men’s Motivation To Compete
Hill reframes patriarchy as an emergent outcome of male competition for resources demanded by women, rather than a co-ordinated male conspiracy. She connects men’s status striving, risk-taking, and overconfidence to evolved mating incentives.
- •Men seek resources in part because women value them in mates.
- •Quote: without women, power and money would be meaningless (referencing Onassis).
- •More men in CEO roles may partly reflect men’s greater willingness to make high-risk, high-cost trade-offs.
- •Male overconfidence and risk appetite can aid status and mating success, even if it leads to more failures.
- 56:00 – 1:06:00
Risk, Entrepreneurship, And Sex Differences In Success
The conversation turns to entrepreneurship and risk. Hill and the host explore how men’s greater propensity for risk doesn’t automatically make them better entrepreneurs; women often excel through more realistic forecasting and measured risk-taking.
- •Men dominate gambling addiction statistics and are generally more risk-seeking.
- •Women are more risk-averse, shaped by their historical role in gestation and childcare.
- •Investor anecdotes (e.g., Kevin O’Leary) suggest female-led ventures may outperform due to better forecasting and prudent risk.
- •Evolutionary explanation: “winning big” yields larger reproductive payoffs for men than women, fueling male risk orientation.
- 1:06:00 – 1:19:00
Bateman Principle, Polygyny, And Men’s Drive For Status
Hill introduces the Bateman principle to explain why men’s reproductive success can scale with partners, while women’s cannot. They discuss polygyny, historical examples, and why most men still choose monogamy despite potential gains from multiple partners.
- •Bateman principle: male reproductive success can rise with each additional mate; female success plateaus after one.
- •Historical and cultural examples of polygyny (e.g., the host’s grandfather with 10–14 wives) illustrate this.
- •Yet most men choose monogamous pair-bonding because involved fathers drastically improve child survival.
- •Women often refuse to share high-value men; a man’s willingness to commit can elevate his perceived mate value.
- 1:19:00 – 1:30:00
Signaling Status And What Women’s Brains Look For
The host asks how women detect high-status males and what cues matter. Hill contrasts men’s immediate assessment of female attractiveness with women’s more context-sensitive evaluations of male attractiveness based on resource signals and behavior.
- •Men’s attraction to women is largely unaffected by occupational status or power cues—looks dominate.
- •Women’s attraction to men shifts with cues like clothing, role, and implied resources.
- •High-status attire or contexts make the same male face more attractive to women.
- •Hill underscores that status signaling and willingness to invest are key male desirability levers.
- 1:30:00 – 1:45:00
The Menstrual Cycle, Estrogen Surges, And Changing Partner Preferences
Hill walks through the menstrual cycle, focusing on how rising estrogen around ovulation boosts women’s libido and shifts their preferences toward more masculinized, testosterone-linked traits in men.
- •Day 1 = first day of bleeding; estrogen rises sharply around day 9, peaking near day 14 (ovulation).
- •During the fertile window (roughly days 9–15), women’s sexual desire, sex frequency, and masturbation increase.
- •At high fertility, women prefer more masculine faces, deeper voices, and socially dominant behavior—cues linked to testosterone and immunocompetence.
- •Lab studies tracking women’s hormone levels across cycles confirm estrogen’s tight correlation with preference for high-testosterone male faces.
- 1:45:00 – 1:56:00
Testosterone, Partnering, And Fatherhood
They explore how testosterone shapes men’s mating and caregiving. Higher-testosterone men are more likely to enter relationships, but testosterone tends to drop in committed partnerships and further after fatherhood, redirecting energy from mating to parenting.
- •Longitudinal data: men with higher baseline testosterone are more likely to be in relationships or married at follow-up.
- •Entering a long-term relationship modestly lowers men’s testosterone; becoming an involved father lowers it further.
- •Reduced testosterone can be adaptive—less interest in new partners, more investment in partner and children.
- •High-testosterone men are overrepresented among those successfully pursuing frequent short-term sex.
- 1:56:00 – 2:22:00
Attraction’s Complexity And Shared Versus Idiosyncratic Tastes
The host reflects on how delicate and unconscious attraction feels, beyond simplistic “hot or not” attributes. Hill distinguishes between shared evolutionary patterns (e.g., men preferring youth and hourglass figures) and individual, idiosyncratic pulls that may reflect deeper compatibility.
- •Attraction is partly idiosyncratic—people often strongly disagree on who is sexy.
- •Some preferences may index genetic or psychological compatibility specific to two individuals.
- •Yet broad patterns exist: men prioritize fertility-linked cues (youth, hourglass shape), women prioritize age-linked status and resource cues in men.
- •She uses George Clooney as an example of women preferring signs of maturity in male faces.
- 2:22:00 – 2:37:00
Competition, Beauty, And Female Intrasexual Rivalry
They examine how women compete with other women, especially attractive ones, in environments with skewed sex ratios like female-heavy college campuses. Physical attractiveness becomes a key competitive axis given male preferences.
- •On female-heavy campuses, women more readily accept men’s preferred casual-sex scripts to secure partners.
- •Women compete most fiercely with other beautiful women because male choice heavily favors beauty.
- •Physical attractiveness is a stronger predictor of a woman’s upward social mobility than her education or class origin.
- •Common tactics include derogation—e.g., claiming a rival has “had work done” to lower her perceived value.
- 2:37:00 – 2:44:00
Gay Male–Straight Female Friendships And Trust
Hill discusses research on the unique bond between gay men and straight women, particularly attractive women. These friendships offer women honest, non-competitive feedback on appearance and dating, filling a niche standard same-sex friendships can’t.
- •Attractive women disproportionately form close friendships with gay men.
- •These friendships avoid two distortions: inter-female competition and male sexual motives.
- •Gay male friends can give trustworthy advice on looks and dating strategies without hidden agendas.
- •This pattern appears cross-culturally, not just in Western contexts.
- 2:44:00 – 2:53:00
Why Hill Wrote ‘This Is Your Brain On Birth Control’
Hill recounts her personal experience of feeling like she “woke up” three months after stopping the pill after more than a decade of use. As a scientist of women’s brains who hadn’t realized how the pill was affecting her, she felt compelled to synthesize the research for others.
- •She used the pill for over 10 years, believing she had no side effects.
- •After stopping, she noticed deeper feelings, renewed libido, more energy, renewed interest in music, cooking, and exercise.
- •She then discovered a decades-long body of research on how the pill alters cognition, emotion, and behavior.
- •Her book aims to translate that science so women can make informed choices about their fertility and identity.
- 2:53:00 – 3:01:00
Five Major Ways The Pill Changes Women
Hill outlines the key domains the pill affects: attraction, sexual function, mood, stress regulation, and physical performance. She reiterates that none of this is adequately communicated to women at the point of prescription.
- •Changes sexual desire (often reducing libido) and who women are attracted to.
- •Raises risk for anxiety and depression; can alter emotional regulation.
- •Blunts stress systems and cortisol responses, with systemic downstream effects.
- •Impairs muscle gain and can affect nutrition and fitness goals.
- •These side effects are rarely thoroughly explained by prescribers, especially to teens.
- 3:01:00 – 3:20:00
Mechanics: How The Pill Alters Hormones And Libido
Hill provides a mechanistic explanation of hormonal birth control: shutting down ovulation via synthetic progestin, flattening estrogen, and suppressing free testosterone. She connects these changes to reduced libido and altered attraction profiles.
- •Progestins signal the hypothalamus not to stimulate the ovaries, halting egg maturation and estrogen production.
- •Combination pills add low-dose synthetic estrogen, but progestin is dominant and natural cycling stops.
- •Flatlined estrogen eliminates the mid-cycle surge that normally boosts sexual desire and function.
- •Pill use increases sex hormone binding globulin, reducing free testosterone in women by about 60%.
- •These hormonal shifts yield more constant—but often lower overall—sexual desire.
- 3:20:00 – 3:36:00
Pill, Partner Choice, And Relationship Stability
They revisit the longitudinal marriage study showing pill-based partner choice can influence later attraction when women discontinue hormonal contraception. Hill stresses these are nudges, not deterministic flips, but can matter for those already on the edge of attraction.
- •Women choosing partners while on the pill tend to favor less-masculine men.
- •Coming off can increase attraction to a handsome partner, decrease it for a less-attractive one.
- •Most couples do not experience a catastrophic shift—effects are typically moderate pushes.
- •Sexual orientation nuances: some women report shifts in same-sex versus opposite-sex attraction when starting or stopping the pill.
- 3:36:00 – 3:51:00
How Men’s Attraction Responds To Women’s Natural Cycling
Hill highlights research demonstrating that men find naturally cycling women more attractive, especially during the fertile window. This includes scent, appearance, movement, and even tipping behavior, emphasizing men’s subconscious tracking of estrogen-linked fertility cues.
- •Men consistently rate women as more attractive during high-fertility phases.
- •Men tip lap dancers/strippers more when the women are near ovulation.
- •Men find fertile women’s scent more appealing and their movements more attractive—even when only silhouettes are shown.
- •The host asks whether having a pill-using partner might lower his testosterone; Hill notes we don’t yet have data but raises it as a plausible contributor to population-wide testosterone declines.
- 3:51:00 – 4:01:00
Testosterone Crisis, Caregiving, And Changing Male Roles
Hill speculates about multiple contributors to declining male testosterone: environmental toxins, reduced exposure to fertile-female cues, and greater male involvement in caregiving. She suggests male roles at home may be feeding back into hormonal set-points.
- •Modern average male testosterone is significantly lower than 50 years ago.
- •Possible contributors: endocrine disruptors, widespread hormonal contraception, lifestyle, and increased paternal caregiving.
- •Testosterone naturally dips when men assume caregiving roles, aligning physiology with parental investment.
- •These hypotheses remain under-researched but are important to investigate.
- 4:01:00 – 4:26:00
Demographics, Fertility Decline, And Population Concerns
Asked whether she fears population collapse, Hill acknowledges concern over declining birth rates and rising voluntary childlessness, but resists framing reproduction as a moral obligation for women.
- •Birth rates are falling; more people actively choose not to have children.
- •She suspects this will have significant societal consequences, though their nature is unclear.
- •Hill is careful not to weaponize this against women or argue that they “owe” births to society.
- •Instead, she sees it as a structural problem intertwined with mating markets, economics, and culture.
- 4:26:00 – 5:25:00
Advice To Young Men And Women In Today’s Mating Market
Switching gears, the host asks what advice Hill gives her teenage son and daughter about dating and becoming desirable partners. She emphasizes balanced masculinity, consent, risk calibration, gym and status-building for men, and patience and better mate pools for women.
- •For her son: be masculine but respectful; understand consent without killing sexual polarity.
- •Low-status young men face a tough market; Hill suggests lifting (muscle, confidence, testosterone) and becoming a genuinely investing, reliable partner.
- •“Bad boys” succeed partly due to testosterone-linked traits (risk, dominance), not because meanness itself is attractive.
- •For her daughter: often the issue is the pool of mates, not her; at 35, generic “get hotter” advice is ethically fraught, though she acknowledges that in practice appearance-optimization influences outcomes.
- •Confidence in women can be attractive, but overt power and dominance often carry a social penalty due to gendered double standards.
- 5:25:00 – 5:43:00
Daddy Issues, Development, And Sexual Strategies
Hill tackles the colloquial notion of “daddy issues,” grounding it in data on father absence and girls’ sexual development. Early paternal disengagement is associated with earlier puberty and more unrestricted sexual behavior.
- •Girls without investing fathers enter puberty earlier than those with engaged two-parent homes.
- •They also begin sex earlier and tend to have more sexual partners over time.
- •Mechanisms may relate to stress, developmental calibration, and perceived environmental instability.
- •Data on links to menopause timing are limited; one line of work suggests reduced ovarian reserve but no clear menopausal age shift.
- 5:43:00 – 6:01:00
Pill, Stress Systems, And Mental Health Risks
Returning to stress, Hill details how pill use blunts cortisol responses, paralleling PTSD profiles, and weaves this into the broader mental-health risk data. She stresses that teens are uniquely vulnerable given brain plasticity.
- •Cortisol spikes to acute stress are helpful; chronic elevation is harmful.
- •Pill users show dampened or absent cortisol increases to stressors.
- •This pattern is similar to that found in trauma survivors with PTSD.
- •Denmark data: 50% higher depression diagnosis risk within six months of starting the pill; risk of suicide attempts about doubles.
- •No robust long-term developmental research exists on teen pill use, but preliminary data suggest higher lifetime major depression risk.
- 6:01:00 – 6:28:00
Her Own Daughter, Teen Contraception, And The Copper IUD
The host presses Hill on what she does with her own 17-year-old daughter. Hill outlines her risk–benefit hierarchy: avoid hormones if possible, especially in adolescence, and lean on non-hormonal options like the copper IUD and condoms.
- •Primary question: is there actual pregnancy risk? If not sexually active, no need for hormones.
- •If sexually active, she favors the non-hormonal copper IUD (the copper coil) as first-line.
- •Barrier methods and fertility-awareness require more planning and self-control—harder for teens.
- •Hormonal implants and pills are effective but impose the full suite of brain and body alterations she’s concerned about.
- 6:28:00 – 6:53:00
Male Birth Control And Double Standards
They discuss ongoing work on male hormonal contraception and why men are unlikely to embrace it, mirroring women’s reluctant acceptance of the pill due to asymmetric reproductive burdens.
- •Current male-contraceptive R&D heavily focuses on suppressing male hormones enough to halt sperm production.
- •Both agree few men would willingly take a pill that flattens their testosterone and alters mood and libido.
- •Women accept such trade-offs largely because they bear the physical and social costs of pregnancy.
- •Hill calls male hormonal contraception just a “shift” of the problem, not a solution; advocates for new, non-hormonal tech for both sexes.
- 6:53:00 – 7:12:00
Emails From Women: ‘You Put Words To What I Felt’
Hill shares the dominant theme in her inbox: women thanking her for articulating experiences they intuitively sensed on the pill—numbness, low libido, disconnection—but lacked language or validation for.
- •Most common message: “I knew something was happening to me; your work explains it.”
- •Many women were put on the pill for non-contraceptive reasons like acne or cycle regulation.
- •Clinicians often downplay mood and libido changes or attribute them to personal failings instead of pharmacological effects.
- •The host connects this to his own past relationship, where his partner lost libido on the pill; only after time off and work on herself did her sexual desire return robustly.
- 7:12:00 – 7:30:00
Reversibility, Teen Risks, And The Need For Better Options
Hill clarifies that for adults, many pill-induced changes are reversible after discontinuation, but teenage exposure remains more worrisome. She reiterates her central call: birth control is not a solved problem; we need innovation.
- •Adult women can typically return to their pre-pill selves after stopping, including libido recovery.
- •For teens, we lack evidence on long-term brain impacts; existing data are concerning.
- •Her stance with her own daughter: if the only alternative is teen pregnancy, she’d reluctantly accept the pill, but sees that as a failure of available options.
- •She urges viewing hormonal birth control as an important but incomplete tool, not the final word in fertility control.
- 7:30:00
Legacy, Empathy, And Understanding Between The Sexes
In closing, Hill states her desired legacy: a world where women are understood on their own terms, and men also grasp how hormones shape female experience. The host reflects on how such knowledge would have changed his own relationships and future fatherhood.
- •Hill’s legacy aim: women understood as themselves, not as defective men.
- •The host describes how learning about menstrual cycles, menopause, and the pill has deepened his empathy and would have altered his past choices.
- •He emphasizes that men, as sons, partners, and future fathers, need this knowledge just as much as women do.
- •Hill reminds listeners that men’s hormones also fluctuate dynamically, even if in different patterns from women’s.
