The Psychological Impact Of Hormonal Birth Control - Dr Sarah Hill

1. 0:00 – 2:23

   Intro

   1. SHDr Sarah Hill0:00

      More recently, researchers have begun to explore the idea that women who are on hormonal birth control, this might be associated with a decreased preference for masculinity, and there is some evidence that is consistent with this. There's been research showing that women who are on hormonal birth control prefer a less masculinized male face relative to what's preferred by the exact same women when they are naturally cycling. (air whooshing)

   2. CWChris Williamson0:24

      How did you get interested in studying birth control?

   3. SHDr Sarah Hill0:29

      Um, well, I spent most of my career, uh, studying women's sexual behavior and, uh, and mate attraction and partner choice, um, and, uh, and I'd even done some work looking at women's sex hormones and the way that influences, uh, women's motivation and choice of dress and other things to that effect. Um, and so I've always had an interest in women's psychology and the different sort of biological components that contribute to, like, sort of what it means to be a contemporary female. Um, but it was really going off of the birth control pill that got me interested in studying its effects on, uh, human psychology.

   4. CWChris Williamson1:05

      What is the way that you would describe to a, uh, non-birth control-taking person like myself the difference in your subjective experience of the world?

   5. SHDr Sarah Hill1:16

      Um, for me, it felt like I woke up. So about three months after I discontinued using hormonal birth control, I started to notice that I was just- had been feeling different recently. I had more energy than I had before. I was going to the gym again. I was, like, noticing men and I was interested in sex in- in a way that I hadn't been in a really long time. I started downloading new music on my playlist for, like, the first time in de- uh, like, in, like, more than a decade. And, um, and I thought to myself, this is... Like, I- I just felt like I woke up and I thought, well, this is a crazy way to respond, um, to going off of the birth control pill. And so I kind of chalked it up to just being me, you know? Oh, it just must be something else that's going on in my life that's making me feel this way. Um, but then I started to really start to dig down into the research and it turned out that my experiences weren't all that unique and that there's been research that's been done now for several decades, um, detailing the different ways that hormonal birth control can influence women's psychology, um, in ways that are very much consistent with the experiences

2. 2:23 – 7:27

   How Hormonal Changes Influence Behaviour

   1. SHDr Sarah Hill2:23

      that I had.

   2. CWChris Williamson2:24

      Okay, so before we get into how the pill affects behavior-

   3. SHDr Sarah Hill2:28

      Mm-hmm.

   4. CWChris Williamson2:28

      ... what do we need to know about hormonal changes and how that influences behavior normally across a woman's ovulatory cycle?

   5. SHDr Sarah Hill2:35

      Right. Well, I think- yeah, and I think that having some background in that can be really useful. And, you know, there's been research that's been done now for, I don't know, three or four decades that's really, um, looked at- at women's ovarian hormones having a really profound role, um, on the way that women, um, experience the world and- and even, you know, the- the activity and structure of the brain. So, you know, research in neuroscience, for example, has shown that as, uh, ovarian hormones change across the cycle, that actually changes the amount of functional connectivity in the brain. It changes, um, the number of dendritic spines on our neurons. So our brain is this very plastic organism within our body that, um, w- you know, sort of changes its structure and function over the course of the cycle. And, uh, behaviorally, what the research finds is that, you know, during the time in the cycle when estradiol is high and the dominant sex hormone, there's a lot of research indicating that, um, you know, women have an increased preference for, um... or an increased desire for sex. They tend to engage in more sexual behavior at this time. They tend to exhibit a heightened preference for cues related to men's masculinity at this time. And so during the- the phase in the cycle which is, um, what researchers usually characterize or- or call the- the periovulatory phase of the cycle, which happens usually between days like 9 to 14, um, on average if you're talking about a 28-day ovulatory cycle. You know, the 28-

   6. CWChris Williamson4:07

      What's- what's day one? What happens on day one?

   7. SHDr Sarah Hill4:09

      Day one you get your period, and so that's how you count forward, right? So after you get your period, usually about, mm, a week and a half after you get your period, women will start to feel more energetic. Um, they'll start to have an- a- changes in libido where they're noticing that they're more interested in sex. They generally have more sex. Um, they're more attuned to cues of, like I said, ma- masculinity, um, in men. They tend to just be more interested in men, um, at this point, uh, compared to other points in the cycle. We have some, um, research showing that women report an increased, uh, interest in- in music at this time, which is very much consistent with the experiences I had downloading these playlists, um, with- that corresponds to fluctuating levels of estradiol. And so, you know, when estradiol is high, it t- you know, it- it's almost like the- the- the brain is being directed toward everything related to sex. And the reason for this is, of course, during this time in the cycle, the body is getting prepared to release an egg, and this is a time when, uh, any sex that a woman might have can actually, uh, correspond to conception. And so, like, evolutionary- you know, the evolutionary process has sort of designed the female brain in such a way that when estradiol is high and an egg is getting ready to be released and women are potentially pregn- impregnant- impregnable (laughs) is that a word?

   8. CWChris Williamson5:34

      It is now. Don't worry.

   9. SHDr Sarah Hill5:35

      It is now. Um, that- that during this time, women are just really cued in to sex and- and signs of, um, sort of, like, genetic quality in partners, and, um, and then once, uh, the egg is released and, um, within 24 hours of that women are no longer fertile and they start releasing the sex hormone progesterone, that hormone is then associated with a whole different set of, um, sort of, uh...... processes that the, that the body is doing, um, in this case, to help increase the probability of, um, implantation, right? And so it tends to make women sleepier, it tends to make them hungrier, um, it tends to decrease their interest in sexual behavior. Um, they're not as interested in men, um, and in, in during this time, it's 'cause the body is solving a totally different set of problems. You know, it's like you can no longer become pregnant from sex, and instead what you need to be doing is sort of staying safe, um, and preserving your energy, um, in the case of a possible, um, implanted embryo, in which case, um, you know, pregnancy takes off. And so this is like a, for women who are not on the birth control pill who are cycling th- the, the, uh, you know, a menstrual cycle or what, what in the sciences we like to call the ovulatory cycle since that's sort of the main event, um, of the whole, of the whole, uh, act. Um, y- uh, it's a waxing and waning between these two hormones, with estrogen being really high and dominant during the first half of the cycle, and that's, you know, generally associated with feeling, um, sexy and energetic and, um, and being sexier to men. And then, um, you know, this progesterone dominant phase which is more associated with sleepiness, hungriness, and for some women, moodiness, um, and a diminished interest in, uh, sexual desire. And so, um, that is the state of a naturally cycling woman.

3. 7:27 – 15:57

   Learning About Hormones Shouldn’t Be Uncomfortable for Women

   1. SHDr Sarah Hill7:27

   2. CWChris Williamson7:27

      What would you say to women that get uncomfortable hearing about the fact that they are kind of at the mercy of their hormones and they're being played like puppets with regards to their drive for sex, their drive for food, and sleepiness and stuff like that? It could be taken as a, a patriarchal struc- superstructure trying to keep women in their place as basically bearers of children or keepers of children.

   3. SHDr Sarah Hill7:52

      Right. Yeah, yeah, yeah. I mean, look, uh, eh, the whole idea that hormones affect how we feel or what we do sounds, uh, sort of scary, especially given the history of, you know, people who are, are, are, eh, like sexist assholes essentially trying to keep women from, you know, getting into positions of power by saying, "Oh, no, they're too fickle because their behavior is affected by their hormones." Um, but the fact of the matter is, everybody's behavior is affected by hormones. Um, and everybody's moods are affected by hormones, and this includes both women and men. And so you know, women, our primary sex hormones estrogen and progesterone, um, change cyclically and very predictably, and with those predictable changes, so too come predictable changes in things like libido and mood. Um, you know, for men, men's primary sex hormone is testosterone, and testosterone also affects men's behavior and mood. So we know that higher levels of testosterone is associated with higher sexual desire, and we know that lower levels of sexual desire are associated with decreased motivation and lower mood. And, um, and for men, you know, eh, even though th- there's a stereotype that women are, you know, unpredictable and fickle because our, our cyclically changing hormones, um, you can actually predict what women's hormones are going to do, which means that you can predict how women are going to be responding to the world around them. For men and their primary sex hormone testosterone, this is not at all the case, because men's levels of testosterone change all the time. They change based on the time of day, they change based on a man's relationship status, so whether he's partnered or whether he's single, they change when he has a child, they change in response to seeing beautiful women, they change when their favorite political candidate or sports team win or loses, they change in response to, um, even the presence of weapons. It's-

   4. CWChris Williamson9:48

      You're kidding me.

   5. SHDr Sarah Hill9:49

      Ne-

   6. CWChris Williamson9:49

      Walking past a gun or playing with guns is going to increase men's testosterone?

   7. SHDr Sarah Hill9:53

      Yes. Just being exposed to guns-

   8. CWChris Williamson9:55

      (laughs)

   9. SHDr Sarah Hill9:55

      ... being in the same room as guns, um, increases men's levels of testosterone. And so, you know, the idea that, "Oh, no, you know, women are so fickle and, and we don't know how they're gonna react 'cause their, you know, hormones change and then that changes their mood and their behavior," um, men's hormones change, men's hormones affect men's mood and behavior, but men's hormones change in a completely un- you know, their primary sex hormones change in a totally unpredictable way. And, um, and, and so the, and so the idea that, um, you know, somehow women are more hormonal than men is just, like, absolutely not true. We're all hormonal, right? And, and the idea that our hormones affect how we think, feel, and behave i- is not at all threatening to women or, or anybody, 'cause that's what they're supposed to do.

   10. CWChris Williamson10:39

       Mm.

   11. SHDr Sarah Hill10:39

       You know, if, (laughs) if, um, if we didn't have our hormones, like, we'd be a disaster, because our hormones are helping to coordinate all of the activities in our body. And if, like, now is a good time for sex, like, our body's rolling out all the stops, um, so that way we're all doing, you know, ev- all the parts of our body are doing it together, like, "We're gonna go and get sex now."

   12. CWChris Williamson10:59

       Yeah.

   13. SHDr Sarah Hill10:59

       And the brain is on the same page and, and the, the genitals are on the same p- everything's on the same page-

   14. CWChris Williamson11:05

       (laughs)

   15. SHDr Sarah Hill11:05

       ... moving in the same direction. Um, and you know, if stress is on the scene, you know, our stress hormones then get all of our body coordinated and doing stress things. And so the idea, you know, of hormonal involvement in behavior, I mean, i- is just an, it's just explaining the biological mechanism or one of the biological mechanisms behind, you know, the experiences of being human.

   16. CWChris Williamson11:26

       Well, if it was the case that the only sex differences that we see are exclusively culturally imprinted, that would make being a man or being a woman basically a fashion choice. That would mean that there's no accrued wisdom from the unbroken chain of survivors that make up the fact that you're here right now. Eh, y- you don't get any of that. And it also means, I, I know that you talk about this, it would make women specifically kinda like puppets of culture. Like, just these gray bits of sludge that usually the patriarchy can come ǔcalm and just-... shape into whatever form it is that they want them to be. Like, th- there would be no- nowhere firm for women to stand in terms of having a nature. There is no female nature.

   17. SHDr Sarah Hill12:14

       Right. Yeah, yeah, yeah. No, I think that there's a tendency sometimes for people to believe that the idea that, um, sex differences are the result of, you know, the patriarchy and culture. Um, it, it, it sounds, uh, on the surface as sort of this, like, pro-feminine i- i- idea, or p- pro-feminist idea, and a lot of people sort of adopt that. Um, but i- i- i- it actually puts r- women in an incredibly submissive position of, you know, saying that, that we're just like passive receptacles of culture, and that the things about us that make us unique from men aren't the result of, you know, inherited wisdom that we've accrued, like as you noted, from our successful female ancestors having successfully survived and passed down their genes from generation to generation to generation. But that instead, it's just, you know, it, it's just, uh, that all of us were too dumb to question these rules that we were being taught and that we were just like, "Yes, we will do the cultural thing. Yes, we will." And, um, and, and that's not... You know, that, that doesn't put women in a particularly empowering, uh, position. And in, in the, in the exclusively culture, um, explanation also, like, really misses, like, wher- it's like missing, like, one really critical piece of, um, sort of, uh, explanatory, I don't know, like, it's, it's n-, it's n-, em, where does culture come from? You know? Uh, it's like culture is the, is a product of the human nervous system (laughs) . You know? It's like culture was created by humans, um, and so that means that it is a product of our brain. A- and like the i- and so culture looks the way that it does because of humans behaving over really long spans of time, and, um, and the idea that, you know, men have been so powerful that they have like created this whole cultural pattern that tends to be repeated the whole world over, and that women for this whole in p- you know, the entirety of, of human history, have just been sitting in the backseat and letting men create culture and tell us what to do, again, it's also just, um, you know, it, it, it, it's insulting.

   18. CWChris Williamson14:23

       Yeah, it does. It treats women like malleable idiots and men like incredibly capable, uh, overlords. And I, I don't think that that's correct on, on either side.

   19. SHDr Sarah Hill14:33

       Mm-hmm.

   20. CWChris Williamson14:34

       There was a... I had Carol Hooven on the show from Harvard. She did that book about testosterone. And, uh-

   21. SHDr Sarah Hill14:39

       Mm-hmm.

   22. CWChris Williamson14:39

       ... she went to go and see red deer in Scotland, these seasonal breeders. And when you're talking about the effect of testosterone on males, she got to see these seasonal breeders where for nine months of the year these deer, male deer, are just chilling with their friends, they're eating. They look not that dissimilar from the females. They haven't got the antlers. They haven't got any real aggression, and they're just with their boys, just chilling out and eating. And then the women come into heat and all hell breaks loose, and they start growing antlers. They start trying to kill every one of the friends they'd just been chilling with a couple of months before. They start trying to kill them. They accrue this harem. They try and have as much sex as possible, and then the women go back out of heat again, and it all changes. And you go, "I... That, that is exactly what's happening with women, except for the fact that men, because you guys have got concealed ovulation, which happens so regularly that it wouldn't do for us to have fluctuations in testosterone associated with that, it means that we're just permanently in antler, have fights with your friends modes." That's it.

   23. SHDr Sarah Hill15:41

       Right. Yeah, yeah, yeah. Or like some sort of media, a happy medium, right? Where it's like you're neither, you're neither constantly fighting with your friends nor, um, chilling in your mom's basement playing video games, but we're kinda like somewhere, somewhere in, in, in between those two things. It's interesting.

4. 15:57 – 29:03

   The Consequences of Using Hormonal Birth Control

   1. SHDr Sarah Hill15:57

   2. CWChris Williamson15:57

      What about when the pill gets introduced then? What are the most obvious changes when it comes to behavior?

   3. SHDr Sarah Hill16:05

      Um, I think that the, probably some of the most obvious ones are, uh, the, the changes in sexual desire, for example. Um, that's a very common, uh, you know, quote unquote side effect that, uh, women get from taking hormonal birth control. Um, and, and the reason for this is because, you know, the way that the hormonal birth control pill works is, um, it essentially tells the brain to not stimulate the ovaries to produce any egg follicles or to mature any egg follicles. And, um, e- the way that it does this is by giving a daily dose of the same hormonal message, which is, um, in, with, you know, the... what's contained in the pill is a relatively high level of this, uh, synthetic progesterone, which is known as a progestin, and then really low levels of, um, synthetic estrogen. And that message, getting that same daily message, you know, either by the pill that you're taking or whatever's being released by your vaginal ring or the shot that you get in your arm or whatever it is, um, that message, when you get it every day, is essentially making the brain believe that it's in the luteal phase of the cycle, which is the phase of the cycle right after an egg has been released and the body is, like, waiting to see whether or not an implanted embryo is going to implant itself. And so, you know, during the second half of the cycle when progesterone... for a naturally cycling woman when progesterone is being released, uh, the brain doesn't tell the ovary, tells the ovaries not to do anything because it's like waiting to see what happens from that last one before it tells it to start stimulating, uh, egg follicles again. And so getting that daily message, high progesterone, progestin, low estrogen, um, shuts that process down. And, uh, and, and this does a few things, right? One, it prevents ovulation, which is great because that prevents pregnancy. Um, unfortunately, um, ovulation, in addition to being something that allows for the possibility of pregnancy, is the primary way by which women produce their own sex hormones. Um, and in particular, the process of maturing egg follicles and getting an egg ready to be released, that's one of the primary mechanisms by which the body produces estrogen.And so when you get that daily message every day of high levels of synthetic progesterone, low levels of, um, estrogen, that's something that's not going to be particularly beneficial in terms of promoting female sexual desire, um, because estrogen is the hormone of, of conception. It's the hormone of sex. And, uh, and, and so we know that all of those changes that we see in naturally cycling women where, um, near high fertility when, uh, an egg is getting ready to be released, when women have high sexual desire, that the mechanism or the driver behind that is estrogen. And so keeping estrogen levels really low, um, is something that is, is not particularly great for women's libidos and it's definitely one of the things that women report experiencing at a relatively high rate.

   4. CWChris Williamson19:02

      What about changes in mate preferences, what they look for in men?

   5. SHDr Sarah Hill19:06

      Yeah, so this is really interesting. And so this is, you know, and, and I noted that it's been about 20 to 30 years now that researchers have been looking at the effects of women's ovarian hormones on their partner preferences. And as noted, um, when women are, uh, at the point in the cycle when estrogen is high, there's been a lot of research indicating that they t- they tend to exhibit a heightened preference for cues to, uh, in particular masculinity. That's the one that seems to be the most, uh, replicable, with, um, women exhibiting a preference for more masculinized male faces, more masculinized male voices, the scent of testosterone. Um, so men with a high testosterone, if you like have women sniffing T-shirts, um, women prefer the scent of men with higher levels of testosterone. Um, and, and so the, there's been a lot of research that sort of links estradiol to testosterone preference. And, uh, so more recently, researchers have begun to explore the idea that women who are on hormonal birth control, given that it keeps your own estradiol levels very low and the synthetics are also, it gives you very low dose, that this might be associated with a decreased preference for masculinity. And there is some evidence that is consistent with this. Um, there's been research showing that women who are on hormonal birth control prefer a less masculinized male face relative to what's preferred by the exact same women when they are naturally cycling. There's been research where they've looked at men who are in committed relationships and they simply asked men, um, and their partners, uh, "Did your partner choose you when she was on or off of hormonal birth control?" And then they took the men's pictures and they sorted the pictures into two piles, right? Piles of pictures of men who were chosen by women who were using the pill and then a pile of pictures of men who were chosen by women who were naturally cycling. And they had them evaluated by an outside group of evaluators who didn't know who was what and, and, you know, it was under what circumstances. And what they found was that both in terms of objective measures of facial masculinity, which is something that you can look at, um, using facial height to width because that's something that's associated with, uh, testosterone levels, and then just having outside evaluators evaluate subjective masculinity of the male faces. Um, what you see is that there are differences between, uh, those two groups of men and that the women, or pardon me, the men who were chosen by women when they were on hormonal birth control, those faces were seen as being less masculine and also sort of scored lower in terms of masculinity using the objective measures relative to the faces of men who were chosen by naturally cycling women. And so all of this, again, is consistent, um, with this idea that the pill could potentially impact our partner preferences. And we have some new research, and I didn't write about this in my book just because we're getting ready to publish this, but we've been, um, we've been working with Natural Cycles, which is a cycle tracking app, um, where they use basal body temperature to, um, sort of track fertility. Um, and a lot of women use it either as birth control to, like, see when they're ovulating and then not having sex or they use it when they're trying to conceive, seeing when they're ovulating so they do have sex. Um, and we, uh, sent a, a, a survey to their users asking them about what type of birth control they were on when they chose their partners and then we tracked the women's sexual behavior over the course of three cycles. Right, so this doesn't necessarily tell us anything about like what i- you know, tell us about your mate, um, but what we were able to do is look at whether or not women, um, who chose their partners when they were on the pill are having less sex with those partners now that they're naturally cycling relative to what you see among women who chose their partners while they're naturally cycling and now they're naturally cycling. Right? And that's exactly what we found. So we found that over the course of the cycle, um, that women who chose their partners when they were on birth control or on hormonal birth control, they have less sex with their partners even now that they're off of birth control than their, um, than, than their counterparts who are on h- who are not on hormonal birth control the entire time. And what's really interesting about it is we also looked at differences in logged libido between those two groups of women and there were no differences in libido, right? So the women who were, who chose their partners when they were on the pill or women who chose their partners when they were off the pill, they both had comparable sex drive. It's just that the women who chose their partners when they were on the pill are having less, you know, like translating that sexual desire into sexual behavior with their partners less frequently, uh, than the women who chose their partners while naturally cycling.

   6. CWChris Williamson23:47

      Why do you think that is?

   7. SHDr Sarah Hill23:49

      I think that what the birth control pill essentially does by flattening our-... you know, cyclically changing hormones and sort of minimizing the role of estrogen in terms of our partner choice and partner preferences and the types of qualities that we're attuned to when we're choosing mates. Um, I think that it sort of downplays the importance of sexiness in a woman's partner choice, and I think that it's just sort of nudging that in terms of like the, you know, women are making choices about a partner, um, you know, you have to make a balance. Like, okay, do I want, you know, somebody who's a really good provider? Do I want somebody, like, with a really interesting personality? Do I want ... You know, we have to sort of pick and choose. And I think that when you have your HPG or your brain o- ovarian axis shut down and you're not experiencing all of the things that estrogen does for women's sexual desire, I think that it makes you downplay the importance of sexiness in your partner choice. And I think that it's like you tend to go after the more intangibles. Or pardon me, the tangibles, right? Like, okay, is this person going to be a good provider? Is this person, you know, stable and, you know, emotionally stable and, and so on and so forth. And there's some evidence that's consistent with this. Like, there, they've been, (smacks lips) um, studies where they looked at how satisfied women are with different aspects of their relationship based on whether they chose their partner when they were on or off the pill. And what they find is women who chose their partners while they were on the pill report more satisfaction with things like their partner's financial resource access. And-

   8. CWChris Williamson25:20

      Oh, because they're going to have assessed them with greater scrutiny around those things, but perhaps sacrificed for stuff like attraction, masculine dominance, maybe status as well would perhaps be a little bit less, uh, important.

   9. SHDr Sarah Hill25:33

      Yeah. Yeah. And they're, and they're ... And nobody's looked at the- the, those last couple of que- like the- the status questions. They did look at, um, you know, sort of like sexual desire and that sort of thing within the relationships. And of course, you know, the women who are naturally cycling reported being more satisfied with the sexual aspects of their relationship, and the women who chose their partners on the pill were more satisfied with the financial provisioning, um, sort of cues in their relationship. And I think that what it does, I think it just sort of tilts the hand, um, in terms of like what qualities are you going after, um, and, you know, for better and for worse, right? Like, there can be a, a ... It- it's- it's not necessarily good, it's not necessarily bad, it just is different. And, um, which is part of the reason I wrote the book. I think that, you know, um, it's just important that we know what we're getting into, um, when we, when we go on the birth control pill.

   10. CWChris Williamson26:22

       Obviously, one of the potential scenarios that you could see happening here is that a woman gets into a relationship with a guy while she's on birth control, comes off birth control, and finds that the dreamy relationship ... Maybe she's coming off birth control because they're about to be married, maybe they've got married and they're now gonna try for a child and they haven't been together while she's been off birth control before, and she finds out that the dream relationship she was in might not be quite as attuned to what she wanted or was attracted to. So, I can imagine that going off birth control can cause a lot of turmoil within relationships.

   11. SHDr Sarah Hill26:58

       Yeah, possibly, you know, and that's a really provocative idea and it's one that researchers have begun to explore, and they found some sort of mixed results on this. But, um, one of the most, uh, sort of carefully done of these studies was one that was a longitudinal study in married couples, and they looked at that very question. Like, like, what happens when you have a married couple and, uh, and the part- ... And the- the- the partner's met when the woman was on hormonal birth control and now she goes off of it? And what they found was that when w- the women discontinued hormonal birth control, it did lead to changes in sexual and relationship satisfaction within the, within the dyad, and the women reported, um, changes in- in both of those things. Um, but it turns out whether it made that worse or made it better depended on how attractive her husband was. And so what they found is that for women who were partnered to really attractive men, when they went off of hormonal birth control, they reported an increase in their sexual desire and an increase in their attraction to their partner. And that's exactly what you'd expect estrogen to do. It's like all of a sudden estrogen is back on the scene, it's like, "Oh my gosh, like, here's my libido and- and sex and this is wonderful and hooray." Um, but for women who were partnered with less attractive men, what they found was the opposite, and that was that they reported a decrease in relationship satisfaction and a decrease in sexual satisfaction and sexual desire in their relationship.

   12. CWChris Williamson28:28

       So, women who have been using the more objective tangible metrics of success in order to judge their partner may have discounted more so the masculinity in the way that they look, but that doesn't necessarily mean that they haven't got with a guy that is very masculine and very attractive. It just means that they haven't prioritized that. They then-

   13. SHDr Sarah Hill28:46

       Exactly. (laughs)

   14. CWChris Williamson28:46

       ... come out of this hormone-induced stupor, and then on the other side of that, they go, "Oh, holy fuck, I'm actually in a relationship with a really attractive guy. Look at how advantageous that is, and now I can have loads and loads of sex." Obviously, I'm being exag- like-

   15. SHDr Sarah Hill28:59

       Yeah. Very.

   16. CWChris Williamson28:59

       ... exaggerating, and also the same thing happens on the other side.

5. 29:03 – 40:44

   Is Birth Control a Cause of the Mating Crisis?

   1. CWChris Williamson29:04

      I've been having a lot of conversations about what David Buss calls the mating crisis at the moment, this sort of imbalance between available guys that fit the characteristics that hypergamous women need and the ever-increasing group of high-performing women. I wonder whether the increased access and use of hormonal birth control influencing how objective the metrics are that women look for in men with regards to education, employment, future prospects, and stuff like that is worsening this hypergamous nature at the moment, and also meaning that s- apps like Tinder and Hinge, which are very easy to put on what your job title is, what your education level is, so on and so forth, I wonder whether this is creating a hormonal profile in women which further predisposes them to choosing these types of ad- objective metrics.

   2. SHDr Sarah Hill29:55

      Yeah. No, that's really interesting. I think that that's, I think that that's a fascinating possibility. I mean, and, and, and how could it not? I mean, it's like we already see the way that, um, that hormonal birth control ... I mean, we see how it's affecting women's achievement. You know, since the pill was made le- like, legally available to women, um, the number of, uh, uh, legally available to single women, which was in the early 1970s, late 1960s, what you see is that the number of women who started doing things like applying to graduate programs, to law school, to medical school, um, to business school, it, it went up by like 1,000%. And it was just because women now could be sure that if they started that program, they could finish. Right? They-

   3. CWChris Williamson30:38

      And the employers as well presumably would be more certain as well.

   4. SHDr Sarah Hill30:42

      Yeah. And so, it's, it's just like, um, y- you know, it just, like, gave women the ability to plan. I mean, it, it's, it's, you know, used to be for, like, people like my grandmother, it was like the idea of going to graduate school would just be stupid because she ... unless she was mono- you know, like, totally chaste.

   5. CWChris Williamson30:59

      Celibate, yeah.

   6. SHDr Sarah Hill30:59

      Yeah. The entire time that she was doing it, the pro- she was probably gonna have to give it up because she was pregnant at some point. And, um, and so for, you know, my generation and, and younger generations and, and, and women who came before me who've also had access to this, like, what a tremendous thing it's done for us in terms of allowing us to make plans and achieve. Um, but because of that, you do have this, like, little bit of a mating crisis. And I have another little nugget for you to, like, chew on while you're thinking about this with the pill and the mating crisis, and this was something that was actually brought ... Do you know, do you know who, uh, do you know who Dave Asprey is?

   7. CWChris Williamson31:34

      Yeah (laughs) . The, like, health guy.

   8. SHDr Sarah Hill31:37

      Proof?

   9. CWChris Williamson31:37

      Yeah.

   10. SHDr Sarah Hill31:37

       Yeah, yeah. Yeah, yeah. So, I did his podcast and, um, he's like, a really smart guy. And, uh, and we were talking about my book, we were talking about the pill, and this was his idea, and I think that he's, like, totally onto something because it's really, it's really brilliant, um, really interesting. But you know, part of the mating crisis, you know, part of it is that women are achieving so much, right? So, like, that's part of it, but the other part of it is that men are just like totally floundering. I mean, just circling the drain. And, um, and so, you know, there is some research indicating that men's testosterone ... You know, we are not red deer, right? Like, our species are not red deer, but men's testosterone levels do seem to be sensitive to the presence of, like, fertile women, right? So, so men, um, there's been studies where they have men, um, you know, having piped in, uh, the scent of, of ovulating women or women during the luteal phase, and you see that testosterone levels seem to be sensitive, um, to, uh, cues of female fertility. And so, what Dave had suggested, and I thought was so interesting, was we have so many women on hormonal birth control, so much ovulation being suppressed, meaning that there are so few cues to estrogen, like, sort of in the air, that could it be that men's lack of achievement motivation is in part driven by the fact that their testosterone is in the toilet, um, because of, uh, the lack of sort of ovulating women to inspire those higher levels of T? And as you know, testosterone levels are at a ridiculous low. I mean-

   11. CWChris Williamson33:16

       1% per year it's declined by since 1980.

   12. SHDr Sarah Hill33:19

       I mean, think about that. And yes, xenoestrogens, and yes, obesity, I mean there's a lot of-

   13. CWChris Williamson33:24

       Microplastics and phthalates and more time inside and blah, blah, blah.

   14. SHDr Sarah Hill33:28

       Yeah, all of that. But, um, even, you know, no matter what they control for, they, there's still some, like, factor X out there that's contributing to, um, these low levels of testosterone.

   15. CWChris Williamson33:39

       Mm-hmm.

   16. SHDr Sarah Hill33:39

       So, I'm gonna throw out there as a possibility the idea that maybe it is, um, a lack of, um, estrogen cues.

   17. CWChris Williamson33:48

       I think that that makes a lot of sense. I mean, r- roll it forward even more and think about the fact that women who are on birth control that then urinate into the toilet, which then gets into the water supply, which then increases the amount of estrogen that's supposed to be consumed by men. No idea if there's any truth behind that at all.

   18. SHDr Sarah Hill34:04

       Yeah.

   19. CWChris Williamson34:04

       But if it's the case that (laughs) taking the pill, women who take the pill are socio-sexually/pheromonally influencing men's testosterone in terms of the fertility cues and also biologically, hormonally, internally influencing men's testosterone, like, you know, roll on top of that poor sleep and higher levels of neuroticism, people spending time in the house, all that sort of stuff, like, yeah, that's gonna drive testosterone down. Now, the fascinating thing is that women who take hormonal birth control are priming themselves for the kind of men that have lower testosterone. So, it's both the cause ... It's like the demand and the supply of the market for this up until the point at which they come off it.

   20. SHDr Sarah Hill34:54

       Right, yeah. And it's like they want the, the, the provisioning, right? Like, like, want a guy who's gonna be a provider, but that also something that's driven by testosterone. You know, we know that men's testosterone levels are associated with, like, mating success and all that on the one hand, but it's also associated with achievement. You know, men who are, are CEOs and, and presidents and, um, you know, in, in high-status roles, um, that's, uh, that's testosterone too. And so, it's like in some ways, like, we're also shooting ourselves in the foot, right? It's like, why aren't there any good men around who are, like, achieving things and, like, being successful? And, and maybe, you know, maybe that has something to do with, uh, what's happening with, uh, with women's, uh, sex hormones. Really fascinating idea.

   21. CWChris Williamson35:41

       So interesting. Didn't you have a ... You had a quote about, um, without women, all the power and money in the world would be meaningless.

   22. SHDr Sarah Hill35:47

       Yes.

   23. CWChris Williamson35:48

       Yeah. I, I think ... Well, there's a, there's a fascinating question to be asked about whether it is a good idea-... for women to have sex with guys who don't have dad-like qualities. Basically, that up until this point, uh, up until the pill was readily available, for the most part, sex was kept until marriage. I'm sure there was sex outside of marriage, there were sex workers and stuff like that. But for the most part, the, uh, bar that men had to get over in order to get into a woman's pants was significantly higher, right? W- what is asking the father for the daughter's hand in marriage? What is that, right? You're going through a final checkpoint of presumably one of the highest scrutiny people in this woman's world to ensure that you have met the criteria. And the point being that if a lot of, is asked of men in order for them to get sex, they will meet that standard, right? If you need to be a pillar of the community with a good job, who looks after his health, who doesn't have a, a, a bad record with the local community, who all of the... da, da, da, da, da, all the way, right? All the things traditionally that men would have been asked to do, that's the case. If what you're asking of men now, because the price of having sex for women has been reduced down so much, if what you ask of men is basically to be in the right place at the right time at the end of the night in a nightclub-

   24. SHDr Sarah Hill37:07

       Right. Yeah, yeah.

   25. CWChris Williamson37:08

       ... men will meet that criteria appropriately as well. Now, I'm not saying that we need to completely withdraw, uh, bodily freedom from women to be able to control their own, like, ovulation and whether or not they're going to have children. But I do think that there's an interesting, interesting question to be asked, like, is it a good idea for women to sleep with guys that they wouldn't want to be in a relationship with, or to sleep with guys that wouldn't make good dads? Because you can- as you continue to drive the market price of having sex with a guy down, increasingly, men will meet that criteria over and over again. And then you end up with questions being asked like, "Where are all the good men at?"

   26. SHDr Sarah Hill37:50

       Right. Yeah. No, I mean, you're right. It's like, um, uh, men will rise to whatever standard is set by women in order to ha- get sexual access. And, um, and sex has been an incredibly powerful motivator of male behavior, you know, since the dawn of time. And, and in, in that quote about, you know, without women, all the power and money and status in the world would be meaningless, um, it's something Aristotle Onassis said, I mean, there's so much truth to that. And that is that for, for men, um, getting sexual access is, um, something that is an incredibly motivating force in, in a, a boy's life as he's sort of going through puberty and the pubertal transition in then a man's life. And, um, and when women don't require a lot of men in order to consent to sex, it does... um, men will sink to whatever low standard is set (laughs) and do sort of, like, what's minimally necessary in order to, um, get access to the partner that they want or the partners they want, um, but not much more. And, uh, and so the idea is, um, you know, that... And, and I write about this in my book, and it's, um, and it, this isn't, again, like, sort of as you noted, and, and I wanna just make sure to hasten to add, this isn't to say that women are somehow responsible for men being lazy asses, right? This isn't like, um, you know... th- that's not our, that's not our cross to bear. Um, it's instead just talking about, you know, when we think about the types of cultural changes that have happened as a result of the birth control pill, this is possibly one of them, and that is that the birth control pill, by allowing us to know that men that we, um, have sex with d- aren't going to be fathers of our children, um, it allows us to have, um, casual sex in a way that we've never been able to have throughout history, um, and, and not have to worry about the long-term consequences. And as you noted, this tends to shift women's preferences, um, in their ch- in their choice of partners in ways that are very much skewed, um, not so much about like is this person a good provider and a good dad, but more in terms of like is this person sexy and might they be interesting for the evening. Um, and so, uh, and ins- and, and that person might not have achieved anything. And so, um, one of the things that, uh, the, the pill may have done by allowing, (laughs) by allowing shiftless men access to sex is, um, reinforced shiftlessness. Um, because if you can get laid... Th- as, this is what I always say and, and like when I'm talking to my grad students about this, I'm like, "If you can get laid while you're living in your mom's basement and eating Cheetos, like, why would you ever do anything different?" You know, you're playing video games in your mom's basement and you're getting laid? Like, I mean, I think like most guys are like (claps hands)

6. 40:44 – 46:23

   How Birth Control Impacts Sexual Orientation

   1. SHDr Sarah Hill40:44

      , "Done."

   2. CWChris Williamson40:44

      Yeah. Well, I, I had a conversation with, uh, Richard Reeves and Scott Galloway and Roy Baumeister over the last few months, and they have blown my head off about young male syndrome and about why we haven't seen roving bands of young guys pushing over granny and causing problems. And it's a combination of getting fake signals of camaraderie and achievement through video games and, uh, Diana Fleischman's idea of uncanny vulvas, that they're getting fake cues of sexual fitness reinforcement from, uh, porn online. Now, if you have been one of the guys that by fortune of charisma or good looks or a good social circle or whatever is managing to bypass the porn want and get casual sex, but still with this, it's, it's going to cause young men to not need to develop a lot of the things previously that would have been asked of them. But I, I gotta tell you about, as I was... (laughs) A story of a, a girlfriend of mine who is a mostly lesbian bisexual, and she usually sleeps with women, that's her thing, but she also sometimes sleeps with men. And I was out for dinner with her, and I was mentioning I was gonna have this conversation with you. And she said, uh, "Well, it's, it's really interesting thinking about the way that coming off the pill changed." And she spoke about a lot of the stuff that I'm sure we'll get into to do with the changes in stress and sort of the depth and color of her emotions and things like that. Uh, but then she said, "One other thing that I noticed when I came off the pill was that for one week out of every month, I was straight again."

   3. SHDr Sarah Hill42:16

      That is like, that's so fascinating. And I guess, I, I can guess which week of the month it was. (laughs)

   4. CWChris Williamson42:23

      Have you ever come across that before?

   5. SHDr Sarah Hill42:25

      Yeah. So, that is something that I've heard from, I can't even begin to tell you, um, how many women I've heard that from. Um, I've heard it from a lot of, uh, bisexual women, um, who, uh, get nudged one way or the other, depending on where they are in the cycle. Um, I've, I've heard from women who thought that they were bisexual and then went on or off the birth control pill and then had that change where they were either completely straight or thought that they were completely lesbian. And so-

   6. CWChris Williamson42:51

      Oh. Is, was there a, did you manage to find a, a significant swing in one way or the other?

   7. SHDr Sarah Hill42:57

      N- you know, it's really interesting because for most, um, the, the thing I've heard the most, but I've heard, I've heard it all, but the thing I've heard most frequently is, um, is that they become a little more straight when they're off the pill. But I-

   8. CWChris Williamson43:10

      So, again, we're looking at the highest rates of bi- sh- bisexuality ever amongst women right now, but we're also probably looking at the highest uptake of hormonal birth control ever. So, how many of the things that we're seeing at the moment, even from men's behavior, is being influenced by the pill?

   9. SHDr Sarah Hill43:28

      I know. I mean, it's, it's k- exactly. I mean, e- exactly. Yes. I mean, i- i- the idea, you know, we've all... Researchers have long suspected a role of, uh, sex hormones, like steroid sex hormones, in terms of, um, sexual preference, right? And, um, and, and the story that you just told and, and the stories I've, I've heard from women are very much consistent with, um, sort of hormonal nudges in terms of, of preferences. And for some women it might just nudge them, you know, right over the borderline into bisexuality and some women it can nudge them right over the side from being bisexual to, um, being fully, uh, heterosexual. In some women it nudges in the other direction. And I actually had this idea, 'cause after I'd heard this story so many times, I started thinking about late in life lesbians and, you know, there's this tendency... And, and, and, you know, culturally we tend to think about this as just being something where women, you know, um, sort of get tired of all the bullshit involved in (laughs) being involved with men and that they're just looking for, you know, companionship and that, and that, you know, and then they start to, like, they form these, um, close and, and even sexual relationships with other women. (smacks lips) Um, but then I started thinking about, um, menopause and, you know, the menopausal transition is this other period of, like, hormonal disruption, right, where you go from a naturally cycling state where you have this waxing and waning of hormones including this big surge of estrogen that surrounds the peri-ovulatory window that's associated with, um, an increased preference for masculinity and maleness and just, like, that sort of thing. And all of a sudden, you know, over time when our ovarian hormones, uh, begin to really rapidly decline, estrogen levels are, you know, very, very low in, uh, in post-menopausal women. And I started thinking about late in life lesbians and, um, and whether that might also, like, be something that's emerging as a result of an actual hormonal nudge where it's sort of nudging women out of the domain of heterosexuality and, or, or bisexuality into, um, into this sort of different mate preference state.

   10. CWChris Williamson45:35

       Well, think about it this way. Let's take grandmother hypothesis, right, why it is that women go through menopause at all so that they can contribute to the rearing of children whilst not contributing more children that need to be reared with one of the explanations that you have for why lesbian women exist at all, which is kind of like a female and female pair bonding, alloparenting agreement type scenario.

   11. SHDr Sarah Hill45:57

       Uh, yeah.

   12. CWChris Williamson45:57

       If you combine those two together, I mean, what better way for grandmother to ensure that her and some of the other women that she needs to look after her children and grandchildren are bounded together sufficiently well that while the guys are out hunting wildebeest or whatever it is that they do, the women get it on a little bit, you know?

   13. SHDr Sarah Hill46:16

       Yeah, yeah, yeah. No, it's such an interesting idea. So, interesting. I find all that so fascinating. So fascinating.

7. 46:23 – 54:38

   Does Birth Control Increase Depression?

   1. SHDr Sarah Hill46:23

   2. CWChris Williamson46:23

      What about the relationship with suicide and depression and stuff like that from women that are on birth control?

   3. SHDr Sarah Hill46:31

      Yeah. So, um, it, it seems pretty clear now from, uh, the majority of the evidence that's been coming out in the last, uh, especially in the last decade, um, that going on hormonal birth control can be linked with, um, an increased risk of, um, anxiety and depression. Um, and this risk seems to be particularly pronounced in, um, adolescent women. Um, so there's been, uh, research looking at the increased risk of, of, you know, going on, um, uh, antidepressants as a function of, of hormonal birth control pill use, um, diagnoses of anxiety and depression, suicide risk as you noted. And, um, what all of this research finds is that being on th- uh, on hormonal birth control is linked with an increased risk in all of these different outcomes, um, but particularly for young women. And so in these, uh, studies they, um, categorize y- uh, young women, these adolescent women as being, um, women who are 19 and younger and, um, and, and, th- for in, in, for these women, um, sometimes, I mean, the risk of anxiety and depression, for example, um, in some cases al- is almost triple what it is for adult women. And, um, it-

   4. CWChris Williamson47:41

      That's just due to their age?

   5. SHDr Sarah Hill47:43

      Just due to their age.

   6. CWChris Williamson47:44

      Right.

   7. SHDr Sarah Hill47:45

      And, you know, and, and nobody knows exactly, like, what the age factor has to do with it except that, you know, the brain is still developing during this time and, um, during brain development, you know, post-pubertal brain development is organized and coordinated by sex hormones. And so you can imagine the brain, the adolescent brain is incredibly sensitive to changes in sex hormones during that time 'cause that's what's coordinating puberty d- you know, pubertal development.

   8. CWChris Williamson48:11

      Mm.

   9. SHDr Sarah Hill48:11

      And, um, and so the idea here is, um, you know, that, that-... the sensitivity to those hormones during that period is probably what's responsible for it. But it also raises the question of whether or not there's long term changes then-

   10. CWChris Williamson48:25

       Are you locking in a more infantilized or juvenile or less developed or abnormal type of protein folding in the brain, or brain structure generally?

   11. SHDr Sarah Hill48:38

       Right, right.

   12. CWChris Williamson48:39

       Wow.

   13. SHDr Sarah Hill48:39

       That might then increase a woman's risk, for example, of mental health problems throughout their lifetime.

   14. CWChris Williamson48:43

       Yeah, you've just locked in this propensity for depression and anxiety.

   15. SHDr Sarah Hill48:47

       Yeah, and there was a, there was a study that was just published ab- um, I think it was about two years ago now, that showed that, uh, women who were ever users of hormonal birth control during adolescence, after they go off it, are still at an increased risk of developing major depressive disorder that continues throughout their lifespan. Um, and there hasn't been very much research on the long term effects of hormonal birth control pill use during adolescence, um, but this is something that, um, i- i- I mean, it seems criminal to me that they prescribe it as frequently as they do to really young women for things like acne, for example, or period cramps or things that aren't nearly as serious and sort of consequential as, as fertility regulation. Um, and there's been almost no research on the, the long term effects on brain development when the brain is still developing. Um, and given that study showing, um, the increased risk in major depressive disorder, um, uh, I, I think that we need to be more cautious and we need to see more of that type of research being done.

   16. CWChris Williamson49:46

       Well, I know that there's a concern around melatonin use in, um, sort of, uh, pre-puberty children 'cause melatonin is used to help people fall asleep. But melatonin is also one of the mediators of the onset of puberty.

   17. SHDr Sarah Hill50:02

       Mm-hmm.

   18. CWChris Williamson50:02

       So, m- melatonin levels influence that. So, if you're giving your child some melatonin gummy, you can actually be affecting when they hit puberty, whether they hit puberty, the cascade of hormones that's going to occur due to that. And yet, no one's thinking twice about putting their daughter onto hormonal birth control. I suppose there's another f- relatively difficult risk. It's probably gonna be a conversation between daughters and mothers or daughters and mothers with fathers sat on the couch being silent, I guess. But for the most part, there is a, a choice here perhaps to be made between do you want to roll the dice with a young, impulsive child who is going to begin to become sexually active at some point within the next half decade and maybe hasn't learned some of the lessons that her mother has done about safety and security and so on and so forth, um, or do you want to potentially put them in a situation that is going to lock in a suboptimal type of brain development? I mean, that's a, that's a brutal decision. How do you, how are you supposed to get to that knowing all of this information?

   19. SHDr Sarah Hill51:11

       Yeah, no, I think that it, it's, it's such, it's such a, a, it puts people into a corner for sure. And in fact, I have a, um, I have a teenage daughter and this is something that I talk about with my friends all the time is like, "What, what do we do? Like, what are, like, the, what are the options?" There aren't good options. Um, and, and so, you know, tha- tha- that's just another reason that having all this information out there is so important because like what people decide is the best option or the least worst option, (laughs) which is often, you know, like what it is, um, is gonna differ for everybody, you know? We're all gonna land on a different square when it comes to like making this type of a decision, which is why I think it's, you know, just another reason it's so important to put all the information out there so that way whatever decisions are being made are b- are being made based on all of the information, you know?

   20. CWChris Williamson52:01

       Also, uh, Jonathan Haidt and Greg Lukianoff's work about The Coddling of the American Mind, obviously in that one of the things that they talk about is this sort of rampant increase in, uh, anxiety disorders amongst young girls, youngish girls, and it's completely in line with the introduction of Instagram and so on and so forth and the, the intrasexual competition and the way that women do it and men do it, you know, females and males is very, very different. And it means that females can be more manipulated more easily through these sorts of platforms because they're more likely to do the backbite-y stuff and they're gonna feel it more blah, blah, blah. Has anyone controlled for the fact that hormonal birth control use is going to be continuing to ramp up at this time? What happens if you discount the base rate that comes from hormonal birth control use?

   21. SHDr Sarah Hill52:44

       Yeah, no, I think that that's a really great question and I don't really think that anybody has probably thought to do that. Like, I don't think that any, you know, it's like, it's, it's too easy to point the finger at social media, um, and it's too... You know, I, I think that, um, people get so nervous about, um, talking about the potential consequences or side effects of hormonal birth control just because of how important it is for women, especially in this sort of dystopian, um, post-Roe era that we're living in. Um, you know, I, I think that there's been a fear that, you know, if we, if we say something bad about it, that it's gonna be taken away from us or, you know, or, or people become afraid of it, uh, become afraid of it or, or that we can't hold on to conflicting information like, like that we can't simultaneously hold that birth control is really important and that it, it's played this huge role in, in terms of, um, women's upward social mobility and economic independence, but that also, you know, it can have some really shitty side effects and it-

   22. CWChris Williamson53:43

       Yeah.

   23. SHDr Sarah Hill53:43

       ... laughs ) brain development and it... It's like I think that we're smart enough to hold both of those two pieces of information-

   24. CWChris Williamson53:48

       No, no, almost, almost no one on the internet is smart enough to hold two different con- conflicting ideas in their mind at one time. If you go on Twitter, like, this is exactly what you see, right? Like, the, the-

   25. SHDr Sarah Hill53:56

       Yeah.

   26. CWChris Williamson53:56

       ... the complexity of the truth is inconvenient for both sides and-

   27. SHDr Sarah Hill54:01

       Yeah.

   28. CWChris Williamson54:01

       ... that, uh, I, you're totally correct and it's one of the reasons that I, I really appreciate the audience that I've got on Modern Wisdom and also everybody else that listens to long form podcasts because you have to be able to take multiple opinions throughout a single piece of content that's very, very long that you're going to both agree and disagree with, and the pace is so much more naturalistic and pedestrian. Even at two times speed, it's nowhere near as close as, as TikTok or Instagram or, or Twitter and it means that you...... you have time to sort of marinade in the ideas and go, "Okay, well that's ... What do I actually think about that? Is it a knee-jerk reaction? Where is this coming from?" So on and so forth.

8. 54:38 – 1:02:12

   Can Men Sense Ovulation in Women?

   1. CWChris Williamson54:38

      So I had Jamie Krems on the show last week.

   2. SHDr Sarah Hill54:42

      Mm-hmm.

   3. CWChris Williamson54:42

      And she taught me about the female rivalry hypothesis for concealed ovulation. Are you familiar with this?

   4. SHDr Sarah Hill54:48

      Yeah, yeah, yeah. It's just this, uh ... Isn't it the idea that women have concealed ovulation essentially to prevent themselves from being targeted by other women unfavorably because if other women saw that they were fertile, that they would, like, essentially murder them in their sleep? So, like-

   5. CWChris Williamson55:05

      A number of things. First off, m- m- murder them in their sleep. Secondly, like socially try and mess with their ability to find mates. But also that if you know when a woman is about to ovulate because she's bleeding or she is, like, showing, uh, visible signs of, of being, uh, in, in ovulation, if you push them sufficiently hard, apparently you can actually mess with the release of the egg overall as well, that you can actually cause it to not happen. So th- this is th- you know, the why is it that women have got concealed ovulation is a question that's been asked for a long time, and there was this theory put forward which is it increases pair bonding between men and women because if you don't know when the woman can get pregnant, you need to have a lot of sex, which increases the pair bond because you've got this difficult baby that you need to look after for the next 12 to 15 years before it can do things on its own, which means that the man and woman actually bind together. She controlled for that, seems like it doesn't work quite so well. Female rivalry hypothesis is super interesting.

   6. SHDr Sarah Hill56:00

      Yeah, yeah.

   7. CWChris Williamson56:01

      How effective are men and women at picking up on when women are ovulating generally at the moment, given the concealed ovulation and all the rest of the stuff?

   8. SHDr Sarah Hill56:11

      Right. Yeah, you know, there's a lot of research that seems to suggest that, um, that there is a preference for ovulating women. I mean, I don't think that ... You know, what's interesting about it is that i- it doesn't seem like anybody's able to mentally articulate like, "Wow, I bet she's fertile." Or, you know, like, sh- "I bet she's ovulating." But there is a lot of research that indicates that, um, you know, we find women more attractive when they're at high fertility compared to when they're at low fertility. And women generally feel sexier, they walk sexier. So they've done studies where they videotape women when they're walking at high and low fertility and then they just show their silhouettes to outside evaluators and, um, they walk sexier. Um, and, and so I think that, you know... I think that there's, uh, uh, a lot of evidence that, um, that we're able to pick up on these cues and that we like them. But, like, in terms of identifying what it is we like, um, I don't know that ... You know, I, I, I think that, um, that there's some things that are better left, uh, to our unconscious mind.

   9. CWChris Williamson57:11

      Yes.

   10. SHDr Sarah Hill57:11

       And I suspect that's one of them.

   11. CWChris Williamson57:13

       Does this mean then that by being on the pill you are potentially going to change the way that other people, both men and women, relate to you?

   12. SHDr Sarah Hill57:22

       Absolutely, yes. And, um, you know, i- i- eh d- all ... Th- there's so much research that points toward women experiencing these, these subtle shifts in their behavior, um, in their physiology even. So we know that women smell differently at high fertility compared to low fertility. Um, you know, we know that dr- women dress differently at high fertility compared to low fertility. W- and, and a lot of these things are, are things that, um, that other people pick up on. And so if you're on hormonal birth control and you're not having these shifts that are being induced by that, that estrogenic state that women get, enter, um, right prior to ovulation, um, I mean, there's no way that that isn't gonna change, um, the way that women come across to, um, other women and then also, of course, to potential partners. Um, and that's again is another thing that's ... it's provocative, right? It's provocative to think about the idea that, you know, being on hormonal birth control might change your desirability to partners. Um-

   13. CWChris Williamson58:25

       Yeah, so women could actually be less attractive to men because they're on the pill because the male, uh ... the back of the male brain stem doesn't know this is an elected, um, reduction in fertility, eh, eh, the difference being this is just a woman that is significantly less fertile than that one over there who isn't on birth control.

   14. SHDr Sarah Hill58:46

       Right. Yeah, exactly. I mean, it seems to me like if I had to ... if somebody were to say, "We're doing a study where we're looking at the desirability of this woman X, right, and we're looking at her desirability to partners when she's near high fertility in the cycle and then we're gonna have her looked at, you know, this exact same woman in their, in the same space and time, um, you know, 'cause th- this is our magical experiment, and she's on hormonal birth control," there's no doubt in my mind that people would gravitate toward the naturally cycling version of that same woman. Like are these differences, you know, something that we would consider like, like are they ... you know, 'cause I, I think they'd be significant. Um, are they meaningful? I don't know. You know, it's like I don't think that, um, uh, uh, sort of, you know, uh, a pill version of a woman compared to a non-pill version of a woman, it, it ... I don't think that it, that they would just get astronomically different types of partners, right? Like, like, you know, "Wow, I went off the birth control pill, I was dating fives and now I'm able to date sevens." Like I don't, I don't think it quite works that dramatically, but I do think that ... I do think it could potentially have implications for, um, for, you know, not only who women choose but like who also finds women most attractive and I thi- I think that's also something that's worth considering, um, when sort of making decisions about the trade-offs that we make when we're on or off the pill.

   15. CWChris Williamson1:00:05

       Why is there no male pill?

   16. SHDr Sarah Hill1:00:08

       Oh, gosh, there's a lot of reasons for this. Um, but primarily, you know, the reason is that women are the ones who get stuck with the pregnancy, um, in the ca- ... You know, it's like we, we are mammals and females, um, are the ones who bear the cost of pregnancy. And so for us, we are significantly more motivated to put up with whatever bullshit comes along with our pregnancy (laughs) prevention techniques than men are. Because for a woman it's like, "Okay, I take this pill and it has this whole long list of side effects. My alternative is pregnancy."... okay, I'll take the shitty pill. For men, it's like, okay, I take this pill and i- it has this huge list of side effects and the alternative to it is my partner goes on the pill. And so for men, they just are like, um, they don't, they won't put up with it. They, they won't put up with the side effects that women will put up with because, because the costs aren't as high. And so, I think that's one of the big contributors to the reason that a male pill has like never really been able to take off. And another reason is, you know, (sighs) it's not, you know, the, it, it would work well in the context of, and, and this is, a- again, it's the same rationale that's driving this, um, but, you know, f- unless you're in a really long term committed relationship where you really know and trust your partner, most women, because they're the ones who have the huge cost associated with pregnancy, um, most women, uh, especially in a casual relationship, would be s- sort of chagrined, uh, to trust their partner to be taking-

   17. CWChris Williamson1:01:39

       Yeah, sure, darling. Of course, I'm on it. Yeah, of course, I haven't forgotten to take my pill today.

   18. SHDr Sarah Hill1:01:44

       Yeah, exactly, exactly. And so I think that there's also an element of control there, which also again boils down to the fact that women are the ones who are bearing the cost of pregnancy. And so it's like we're, you know, one, more worried about like whether or not it's being used correctly, and so we're less likely to trust men to take it right. And two, men aren't as motivated to put up with the, the bullshit side effects that women have to put up with to, to stay on it, because men's, men's alternative is far less grave than ours.

9. 1:02:12 – 1:09:45

   Looking to the Future of Birth Control

   1. SHDr Sarah Hill1:02:12

   2. CWChris Williamson1:02:12

      In summary-

   3. SHDr Sarah Hill1:02:13

      Mm-hmm.

   4. CWChris Williamson1:02:14

      ... moving forward, what do you think is the future of birth control then? Because it seems to me at the moment, I, I have no idea, I had no idea until I started having chats in preparation for speaking to you today with some girls that have been on the entire litany of different birth control options, and it seems like all of them have side effects, whether it's the coil, whether it's the once every three months injection, the little bar thing that goes on the inside of the bicep, whether it's taking the pill, uh, th- the only one that seems to be relatively side effect free is the thermometer under the tongue thing that you were mentioning earlier on that you link in with an app and blah, blah, blah. But I think there's a bit of trepidation for using that because f- to girls it feels like less certain somehow, uh, uh-

   5. SHDr Sarah Hill1:03:02

      Okay.

   6. CWChris Williamson1:03:02

      ... anyway, my point being, what, what, what, what's going on? We've, we've listed today a pretty uncomfortable, uh, variety of side effect both to men and women, both physiologically, sexually, culturally, psychologically, short term, long term, during development, post-development. Um, w- what, i- is there anything that can be done?

   7. SHDr Sarah Hill1:03:26

      Yeah, you know, I think that the future of, uh, birth control is going to be something that is not hormonal but works just as effectively and, um, and works sort of within the body. Um, and so just to give an examp- but, but I think we need to get more clever about it. You know, I think that sometimes there's, there's a tendency for like procedural inertia, right, where it's like, oh, well, hormonal birth controol- troll works, so let's kee- let's put all, let's keep focus on that. But it's like, all right, like let's scrap that idea, you know, like let's just forget about hormonal birth control for a minute and really get creative about what is it that's r- you know, produces sperm and what produces eggs and how do eggs transport themselves. You know, like what if, you know, and this is like a ridiculous idea, but, um, so don't try to invent this, but I mean what if there was like a, a, a little, you know, shunt, uh, that you could like put in the, or like a little, a little, um, almost like a, like a pinball machine flap that could be like right outside the ovary and the, and the fallopian tube or whatever that bats the egg out and like just has it float around to get reabsorbed in the body. I mean, we just have no idea. You know, because everybody's been focusing on this like one thing, and I say like forget that. Like let's like actually sit and think about the mechanics of, of, um conception and, and see if there's a different route. Um, and, and one thing that I, that I heard about, um, and this, this was only about six months ago, and it was done in mice, and so this is obviously a very long way from humans. But this was a, a study that was done in mice where they found that if you block absorption of this like derivative, of vitamin A, that doesn't seem to do anything in the body except for help to promote, um, spermatogenesis. That if you block that in male mice that they can't produce sperm, and from what they can tell, it doesn't seem to be used in any other systems in the body except for that. So, if that ends up being true, which it might not be because, you know, our body is a mess of spaghetti because of the evolutionary process that designed us. And so lots of things are used for lots of different reasons, and sometimes we don't even know what they are. Um, so it may end up that this vitamin A derivative is also really important for heart valve function or something that we just don't know yet. But if it, if it is actually just kind of the thing that it does, and we're able to block absorption of that, that's great. We're done. You know? I mean, and so it might be something that simple. Um, and so that's gonna be going into clinical trials as soon as they do s- a little bit more animal preclinical work on it to see whether or not it continues to work. But I think it's going to be something that gets away from hormones, um, and is, is sort of, is, takes us from square one where we just ask ourselves, what are the mechanics of conception? What are the c- what are the mechanics of spermatogenesis or oogenesis, um, that we can potentially disrupt, um, to really then disrupt, um, the way that we're doing birth control in, in a way that's gonna have fewer side effects for men and for women.

   8. CWChris Williamson1:06:17

      And the problem is that at the moment, we have a solution which is pretty far from perfect, but kind of gets the job done.

   9. SHDr Sarah Hill1:06:23

      Yeah.

   10. CWChris Williamson1:06:23

       And it's ... Right, okay. It's like, "We'll just shelve that. We don't really need to worry about that, uh, and let's get on with bigger, bigger problems," whatever they are.

   11. SHDr Sarah Hill1:06:31

       Right, yeah. No, I think that there's this, um, this cultural perception that birth control as an issue for women is solved. And so part of the, you know, the big, uh, motivating factors for me writing the book was just like to really make people aware of the fact that no, this is not solved, and that there's, you know, there's a huge psychological burden, uh, that women get under when th- when they're going on birth control pills. And most women who are on birth control and, and, you know, have side effects from it. And, um, and, and when you talk to women about their birth control and you're like, "Hey, how do you feel about your birth control?" They're like, "I love my birth control. It makes my hair fall out and I don't wanna have sex anymore, and I get this weird bleeding cramping thing, but other than that, it's great." Or, "I love my birth control. Now, I am in a terrible mood all the time and I have all this anxiety and I'm on this antidepressant and that antidepressant and, you know, this and that and the other thing, but my birth control is great." And I think-

   12. CWChris Williamson1:07:22

       Not pregnant though.

   13. SHDr Sarah Hill1:07:23

       Yeah, not pregnant. I mean, and, and that's like how low our standards are because that's how little we ... how few options we've been given as women. And so, um, you know, I, I think that we need to put more cul- cultural pressure on the development of new, um, new types of birth control. And, and I think that, you know, I think that there's a lot of people in private industry that are doing that now, you know, with the rise of, you know, quote-unquote femtech, um, we're beginning to see that there is a greater investment going into these companies that are, um, going to hopefully be disrupting in a positive way the landscape of, uh, of contraception for women.

   14. CWChris Williamson1:07:55

       And also the concern that you have, again, amongst women that any criticism of birth control writ large is potentially rolling back further developments that have been rolled back relatively recently as well.

   15. SHDr Sarah Hill1:08:09

       Yeah. No, I think that having, um ... I think that having, uh, conversations about birth control is always, uh, tricky just because of just how important it's been to women's, um, sort of, uh, financial and economic independence, political independence, our ability to be able to care for ourselves, and so I think that people are t- are pretty touchy about-

   16. CWChris Williamson1:08:28

       Yeah, I mean, if you'd been a guy and written that book-

   17. SHDr Sarah Hill1:08:31

       Oh, yeah.

   18. CWChris Williamson1:08:31

       ... I imagine.

   19. SHDr Sarah Hill1:08:31

       I wouldn't have been able to write that book as a guy, you know? I mean, it's just, um, it's too important to women. Um, it's too important to women, uh, to have it be seen as something that's under threat. And so like as I wrote my book, um, one reason I, I also wanted to be the person who wrote it is, um, I, I think that I can, uh, pr- I was able to present things in a very balanced way, um, where I talk about, you know, here is the range of potential psychological effects that you might experience, um, but this doesn't mean you should be ... not be on it and it's bad because I, I don't think that anything is bad and nothing is good. It's like there's information and for each one of us, we need to sift through that information and then make decisions about ourself because it's like I know what works for me, but that doesn't mean that I know what works f- for you. And so it's just really about providing all of the information in a really even-handed way, um, where, uh, I, n- I think yeah, in, in sort of having that conversation in the context of just how important, um, this has been for, for women in terms of, um, uh, putting us in the position that we're in now, um, economically and, and, and socially.

   20. CWChris Williamson1:09:43

       All right, Sarah. Let's bring this one home. Where should

10. 1:09:45 – 1:10:26

    Where to Find Dr Hill

    1. CWChris Williamson1:09:45

       people go if they want to check out the stuff that you do online?

    2. SHDr Sarah Hill1:09:47

       Um, they can find me online at sarahehill.com, and that's Sarah with an H. Um, and you can also find me on all different, um, social, uh, different social media platforms, and my handle is @sarahehillphd.

    3. CWChris Williamson1:10:04

       Sarah, I appreciate you. Thank you.

    4. SHDr Sarah Hill1:10:06

       Thanks.

    5. CWChris Williamson1:10:06

       What's happening people? Thank you very much for tuning in. If you enjoyed that episode, then press here for a selection of the best clips from the podcast over the last few weeks. And don't forget to subscribe. Peace.

Episode duration: 1:10:26