What else birth control does
The Gist: Everyone, women and men, should get up to speed about birth control and its side effects for themselves, their significant others, their daughters, their friends.
Co-authored with my wife, Ashley Starrett.
About 70% of American women will use hormonal birth control at some point in their lives and you should care, not just because America’s fertility rate is below replacement, which you might dismiss because the national interest pales in comparison to your interest in consequence-free sex, but because “birth control” does a lot more than the title.
Figure 1. Contrary to some reports, it does not automatically transmogrify you into a lonely old cat lady
For example: women on birth control have cortisol levels that look like they are veterans with PTSD. Cortisol is the natural body reaction to stress; indeed, “a cortisol surge is so characteristic of the stress response that it’s one of the ways that scientists are able to gauge whether something stressed someone out.” Dr. Sarah Hill explains: “Lacking this capacity isn’t a ‘get out of jail free’ card for stress. Instead, it means that when we’re stressed out, we’re less able to cope. It predicts problems with emotional regulation, learning, memory, and social functioning. Even though stress seems bad, I promise you that lacking a stress response is decidedly worse.” And indeed, “Even though too much stress can make us feel cranky, irritable, and overwhelmed, too little stress can make us feel sad, bored, and like we’re living in blahsville.” Which is all the worse because “stress isn’t necessarily synonymous with the sh** hitting the fan. Sex, physical attraction, getting exciting news, and Christmas morning are also powerful elicitors of stress.”
Figure 2. Turns out that being in ‘Nam is not so different from being in NOW.
Today we’ll be reviewing This Is Your Brain on Birth Control, which Grant’s wife initially found odd that he was reading (and discussing with his book club) but was immediately intrigued and devoured the book herself (and now is co-authoring this review [Hi!]). Obviously any mention of birth control is controversial and politicized because it is so important to so many people but this book is especially insightful because it is not written by some ancient celibate male Catholic bishop intoning about theology but by a liberal female psychologist who spent years doing what America encourages our best and brightest to do, pursuing years of education, delaying family formation, and then suddenly, when the time came,
“A couple of months after going off the pill, I realized that I felt . . . different. I didn’t notice it while it was happening, but one day I realized that my life had recently felt brighter and more interesting. Like I had walked out of a two-dimensional, black-and-white movie into a full-color, three-dimensional, meaning-filled reality. I started exercising again and cooking—things that I used to take a lot of pleasure in but had kind of forgotten about. I had more energy. I noticed attractive men. I cared about how I looked in a way that I hadn’t in a long time. I just felt . . . alive. Like, fully, vividly, awesomely, humanly alive. This didn’t happen all at once. I didn’t realize that any of these changes were happening until after they had happened. I just one day realized that I felt awake from an almost ten-year nap I hadn’t known I was taking.”
Figure 3. Usually this kind of experience only happens when you are going ON drugs
As Dr. Hill explains, you are your hormones (and your nervous system/brain), “and when you change your hormones—which is what hormonal contraceptives do—you change the version of yourself that your brain creates.” Let’s briefly brush up on our biology: Hormones are the body's chemical messengers, playing a crucial role in regulating almost every physiological process. “The primary job of hormones is to keep all our bodily systems on the same page about what the body should be doing at any given moment in time. Although this is something that most of us take for granted, imagine for a moment how much of a mess you’d be in if half your body thought it was preparing for sleep while the other half thought it was running from a bear.” So, when you’re messing with your hormones, you’re not just messing with the menstrual cycle and potential for childbirth; hormones also coordinate “digestion, metabolism, sensory perception, sleep, respiration, lactation, stress, growth, development, sex… mood, and anything you’ve ever done in a bathroom with the door closed.”
You're effectively tweaking a sophisticated communication network that affects your entire being. This alteration can have a ripple effect, influencing various aspects of your health and behavior. The idea is akin to a symphony orchestra: if one section, say the strings, changes its tune, it doesn't just affect the harmony of the strings but alters the entire performance. In the same way, hormonal contraceptives, while targeting reproductive hormones, can indirectly influence other hormonal pathways and processes in the body, thereby impacting the 'symphony' of your physiological functions.
“For women, the predominant sex hormones are estrogen,” which even the average man recognizes is a thing, “and progesterone” and they cycle in dominance. “Estrogen is the hormone that’s responsible for most of the things that we think about when we think about what makes women, women. For example, it’s responsible for the development and maintenance of things like breasts and hourglass body shapes, as well as the development and regulation of the reproductive system. Estrogen is also instrumental in getting your body ready for the possibility of pregnancy each month, as well as motivating behaviors that make pregnancy possible.” On the other hand, progesterone “helps coordinate all the nesting-related activities that help prepare the body for the possibility of embryo implantation, and helps close off the cervix to any germs or sperm(s) that might try to make their way in after conception has occurred. When progesterone is on the scene, women tend to feel hungrier, sleepier, and more relaxed than they do at other points in the cycle.”
Hormonal birth control tricks the body into thinking it is already pregnant or in a phase where ovulation (the release of an egg from the ovaries) should not occur. It does so by releasing synthetic hormones which mimic the changes in a woman’s cycle. Notably, “the majority of synthetic progestins” in birth control actually use the male sex hormone, testosterone, the consumption of which “might have masculinizing effects that you never bargained for… prompting things like breakouts, weight gain, and hair growth in places that you probably don’t want hair. Some research suggests they may have some masculinizing effects on the brain, too, doing things like decreasing verbal fluency and increasing performance on mental rotation tasks.”
Ironically, according to Hill, women who are on hormonal birth control - the magical device that tries to free sex of consequences - experience smaller sexual appetites, are less inclined or able to attract men, and are attracted to different kinds of (arguably less sexy) men. Just imagine how few men would take birth control if the equivalent were true.
Hill cites a variety of studies that suggest less sexual interest (e.g. women on birth control who are shown pornography much more quickly lose interest in the main action and examine the scenery; women on birth control who are shown the romantic classic the Notebook are less chemically turned on). Though this is probably not the intention (or within the knowledge) of most birth control consumers, arguably this could be valuable if they really do want to focus on career and not relationships; or, here’s a wild interpretation: it may even be useful as an aid to abstinence for those who want to pursue that.
As an evolutionary psychologist, Hill has quite a lot to say about how men and women have pursued mating strategies. For men, mating effort begets status-seeking achievement; for women, “mating effort begets beautification effort.” For those off the pill who actually really experience their cycle, “research finds that women feel sexier, are more open to new experiences, and put more effort into their appearance at high fertility than at low fertility across the cycle. Women at high fertility also wear more makeup, wear sexier clothes, buy sexier clothes, and wear more red, which is a color known to make women appear particularly attractive and desirable to men.”
More importantly, whatever is going on actually does appear to work on men; here are summaries of the studies with variant levels of creepiness:
“Researchers also discovered that men and women find photographs of women’s faces that were taken at the fertile phase of women’s cycles as being more attractive than photos of the same women’s faces taken at a non-fertile phase. Similar effects are found for vocal recordings”
“Several studies have found that women’s natural body scents collected at high fertility (usually by way of collecting T-shirts worn by the women) are rated by men as being more desirable and pleasant than scents collected at low fertility. This relationship is not observed for women on the pill, who lack a cyclic estrogen surge.”
Exotic “dancers earned around $70 per hour [in tips] when they were near ovulation. They earned around $35 per hour during their periods. And they earned around $50 per hour at other times, when fertility was waxing and waning. Women on the pill averaged around $37 per hour, with no peaks and valleys, like those observed by the naturally cycling women.”
Figure 4. You can imagine who volunteered to conduct this last study.
Of course, the fact that a woman is much more willing to have sex while on birth control takes care of a lot of the difference with lustful men. But birth control exerts a complicated influence on women’s choice of partners. Women on birth control tend to think with their head, choosing stable providers and cooperative partners who will be good dads - but also experience more sexual dissatisfaction when they get off birth control, though the total recipe adds up, perhaps as just a correlation, that women who meet their husbands on birth control are “significantly less likely” to divorce.
Women off birth control instead choose, when estrogen is high in their cycle and they are most likely to conceive, testosterone-heavy sexual partners who are “tall, symmetrical men with deep voices, ambition, and swagger,” regardless of whether they are actually good long-term mates. Which sounds like a slam dunk for birth control, except that these “these qualities provide cues to things like health and developmental stability, which create more successful pregnancies and healthier children.” In particular, “estrogen tends to heighten women’s preference for the scent of men… whose immune genes are different from their own.” Hill reports on the sad irony of wanting not yet to have children and then finding someone to have children with whom it is actually more difficult: “couples with similar immune genes may have more difficulty getting and staying pregnant,” specifically, “couples with a history of unexplained miscarriages finds higher-than-average levels of genetic similarity in immune genes between the mom and dad from what is observed in couples without this history.” Even when couples do get pregnant, “when comparing the health of the children born to couples who met on the pill with those of couples who met without it, the researchers found that the children born to couples who met on the pill had the poorer overall health.”
Figure 5. Men are encouraged to think with their big head, not little head. Should women think with the pill, not off it? Evolutionary psychologists actually argue that the optimal birth strategy for women is to pair off with a cooperative partner / father figure but cheat on him with a healthy swaggering alpha.
So far we’ve been mostly talking about the way that birth control affects women in sexual matters which seem at least adjacent to its main purpose. But as referenced at the very beginning with respect to the cortisol levels of women on birth control, the side effects are more widespread, and let’s talk about perhaps the worst: In a gigantic million-women decade-plus study in Denmark, “women who were on hormonal contraceptives were 50 percent more likely to be diagnosed with depression six months later,” and it was worse for girls under 19. Relatedly, tragically, “The women who were on hormonal contraceptives were twice as likely to have attempted suicide [over the 8 year period for each woman examined] than the women who were not on hormonal contraceptives.” And the longer you’re on oral contraception, the greater the likelihood of being diagnosed with alcohol dependence.
These are correlations - it’s totally possible that women on birth control have a variety of other things going on that women off birth control do not, most obviously and importantly more sexual interactions with men. But as we have discussed this book with friends and acquaintances, lots report direct effects of birth control itself, including extreme sadness, lethargy, anger, anxiety, and more. Like many girls, Ashley was prescribed birth control at 14 to treat a common period problem (for which it had little effect) but was encouraged to continue taking it without any notion of side effects until an insurance shift prompted a switch in medication that led to severe stomach pains. Ashley's mother now says that if she had known what is contained in this essay that she would not have let her take birth control that early. Hill confirms that these effects are not just anecdotal, saying that every woman knows women who had bad reactions, though she also notes that some appreciate that birth control can make them feel less emotional. But the point stands from earlier: your hormones are you. The good news with some of this funkiness is that hormonal “birth control” isn’t just one thing - there’s a variety of products that have slightly different compositions and they can affect your mood in different ways. But it is often very hard to self-evaluate when you’re having these feelings and to directly connect it to your birth control, especially when there’s so little discussion of this kind of side effect. And, to the men in your life, it’s usually a complete mystery either too sensitive to be broached or too complicated to understand.
What we’ve also discovered in talking to people is just how little of this information is known. Which is a real problem. Again, we’re talking about 70% of American women at least at some point in their lives. Because people think that any discussion of birth control’s side effects will invite it being made illegal, it’s a whispered conversation. Or as Hill explains, when answering the question, “why didn’t I know this already?”
“Women are motivated by their desire for safe, affordable, effective, and easy-to-use contraception. Men are motivated by pregnancy avoidance, too, but also by their desire to keep sex easy to come by and an intense hatred of condoms. Doctors are motivated by their desire to serve their patients and stay in business. None of us want to go back to living in a time when women weren’t able to exercise all but complete control over their fertility. So the answer to this, for many of us (I am included in this group) has been to develop a blind spot when it comes to the pill, never questioning the wisdom of changing a woman’s hormonal profile in the name of pregnancy prevention. The pill has done so much to improve women’s lives that entertaining the possibility it might do things to women’s bodies that we don’t want it to is simply not an option for a lot of us. The stakes are too high. Our brains use every trick in the book to make sure we perceive the world in a way that supports the view that the effects of the pill are limited to the ovaries, plus a small handful of other minor systems involved in generating so-called side effects. And this is true despite the fact that adhering to this belief, for some women, requires nothing short of a complete betrayal of their own experiences.”
As Hill points out, there is a hormone regulator that is heavily regulated for men:
“Consider for a moment the differences in the way we treat birth control pills and anabolic steroids, those drugs favored by athletes who don’t mind cheating to win. The primary ingredient in steroids is a synthetic version of the primary male sex hormone, testosterone. These synthetics work by stimulating testosterone receptors and getting cells to run their testosterone program. This causes the body to experience changes like increased muscle mass, skin breakouts, and the magnification of certain male-like behavioral traits (like bar fighting and wall punching). Now, as you are probably well aware, anabolic steroids are illegal without a prescription. They are classified as a Schedule III controlled substance and—if you’re caught with them—you’re looking at a $1,000 fine and up to a year in prison. Steroids, because they stimulate hormone receptors, have a wide range of effects on men’s bodies and brains. When taken over long periods of time, these changes can be bad for men’s health…. We worry about men using artificial sex hormones because of all the effects they have on the body. At the same time, women are routinely prescribed female sex hormones and kept on them for years at a time despite all the effects that they have on the body.”
But the benefits of big muscles are far smaller than not having children when you don’t want them. Still, birth control’s real function in politics is as a bogeyman to motivate left voters even though practically no one on the right wants to ban it (even a large percentage of self-identified Catholic American women use it in defiance of Rome’s policy); this is such a severe fear that giving women clear knowledge and a choice about what to put in their bodies is obscured and neglected.
Figure 6. A number of baseball major leaguers would be inclined to disagree about the relative value of muscles
It’s undebatable that birth control radically changed society and it is worth reflecting on its broader social effects, all the more so because it is not going away. As Hill the evolutionary psychologist explains, when sex had more likely consequences for women, women were choosier (to avoid deadbeats). “When sex is no longer difficult to get, men lose what has been the most powerful naturally occurring motivator of achievement out there. So although the pill and the freedom it allows may be responsible for the fact that women are now able to achieve more than ever before in history, it may have the opposite effect on men.” Combine this with the universal ease of pornography accessibility, and it’s no wonder that men are falling behind: where’s the motivation? More obviously, birth control is contributing to lower fertility in the United States - and importantly, women winding up having fewer children than they themselves say they want to have (Family planning is a euphemism for family prevention.) On the other hand, while a certain brand of conservative might immediately be horrified that birth control leads women to prefer more feminized men, it also appears to be leading to women pursuing more successful marriages with stable providers, a conservative dream.
Ultimately, what does all this mean for you and the women you love? “You are a different person on the birth control pill than you are when you’re off the pill. And there’s no bigger deal than this.” In a letter to her daughter, Hill advises “If you aren’t having sex yet, I would say hold off [on the pill] as long as you can” and “If you are serious about avoiding pregnancy, you can do it. With the pill or without it.” If you do take hormonal birth control,
“Any time you start a new pill, please let someone close to you know about it. Ask them to make note and tell you if they notice any changes in your behavior that might suggest the onset of depression…
“On top of this, I think that you should consider keeping a journal. If possible, start before going on the pill so that you have a written log of how you were feeling before and after. The brain likes to play tricks on us when we are sad or anxious and tells us we have always felt that way…
“Here’s what you need to ask yourself if you go on the pill:
Do I feel like myself on the pill?
Have my behaviors changed since going on the pill?
Has my mood changed since going on the pill?
Have my relationships (both sexual and nonsexual) changed since going on the pill?
Has my performance at school or work changed since going on the pill?
Have my interests changed since going on the pill?
Have my motivations changed since going on the pill? Am I more or less motivated to do things that I used to like to do before going on it?
. . . AND THIS IS THE BIG ONE . . . How do I feel about all this?”
If you find yourself in a position where you are being prescribed antidepressants, consider going off the pill first and seeing how you feel. It may be worth taking regular breaks regardless just to make sure you know (and remember) the difference in how you feel. Don’t settle for a single medication and be willing to switch many times to find the right one; find a sensitive, informed doctor to discuss all this with. If you meet a great guy while on the pill and are thinking about getting married, consider a drug holiday to see if you remain attracted to him (though make sure you don’t find yourself in a situation where you cease being attracted and get pregnant). Hill even suggests that perhaps you should generally not be on the pill, then if you find someone your hormones are directing you toward, only then consider going on the pill if and when the relationship advances to having sex.
Notably, Hill reports “I spent more than a decade of my life on the pill, and I’m pretty sure that I’m better off for having been on it” but you may read all this and come to a different conclusion. As Hill says: “Although the pill has done a number of amazing things for women… these wonderful things come at a cost. Some of the costs are pretty significant, too. And the thing that’s troubling about them is that most women have no idea that they’re paying them… Treating the pill as the big deal that it is will require a major course adjustment for all of us. We’ve all been far too cavalier about making changes to women’s sex hormones.” Ashley advises that you should not necessarily completely reject birth control but that no one should consider it without a full understanding of the consequences. As Thomas Sowell says, there are no solutions, only tradeoffs.
Figure 7. This is a good book to start to, shall we say, get redpilled about the pill. If you’re a conservative (which you probably are if you’re reading my substack), then know that this is not a book that is going to complement your every feeling. Though Hill apparently feared some cancellation over writing this, she also has eye-rolling sentences like: “Most of the research I discuss in this book is focused exclusively on the experiences of heterosexual cisgender women, because they are typically the people who go on the birth control pill. Although some lesbian women, as well as transgendered women and men, go on the pill for reasons other than pregnancy prevention, research hasn’t quite caught up with this yet.” But there’s plenty of interesting, novel information for the discerning reader, like “Single women at high fertility skewed slightly more liberal than single women at low fertility. Partnered women at high fertility, on the other hand, skewed slightly more conservative than partnered women at low fertility.” I’ll conclude with this block quote that has little to do with birth control but is just a wild statistic reinforcing evolutionary psychology:
“Although the average rate of non-paternity (which is what we call it when men think that they’re the father of a child that actually isn’t theirs) for men who report feeling highly certain about being the biological fathers of their children is somewhere between 2 and 4 percent, for men who feel relatively less certain about their relatedness to their children, the rate is closer to 30 percent… Because of this, men tend to be more discriminating than women in terms of how much they invest in their kids, investing more in those whom they feel are more certainly theirs and less in those for whom relatedness is more dubious. For example, in one study, researchers had external judges evaluate the facial resemblance of children to each of their parents. They also had the parents rate their perceived similarity to their child and report their psychological and emotional closeness to their children. What they found was that mothers’ facial resemblance to their children did not predict their emotional closeness to their children at all… For the dads? [I]t mattered. A lot.”
Thanks for reading! If you enjoyed this, forward it to a friend: Know anyone who is on birth control? How about anyone who cares about the health of half of our population? Or do you know anybody who may encounter a woman?
If you liked this, be sure to check out my other newsletters, including this profile of Margaret Thatcher.
If you’ve received this email from a friend and would like more, sign up at www.grantreadsbooks.com or shoot me an email at grant@grantstarrett.com with the subject “Subscribe.” I read over 100 non-fiction books a year (history, business, self-management) and share a review (and terrible cartoons) every couple weeks with my friends. Really, it’s all about how to be a better American and how America can be better. Look forward to having you on board!