B (2:44)

Right. Well, I think that the reason that it feels so terrible to women is in part because, you know, most of our ideas about what it means to be human are based on a male ideal. I mean, men were studied first. And so most of the wisdom that we're given about, like, how much sleep we should get, how many calories we need, what type of exercise that we should be doing, all of it's based on a one size fits all model that works for a male body. And then when women were finally included in research, they only included women during the first half of the menstrual cycle, specifically during the first couple of days of the menstrual cycle. So that way they could minimize the impact of women's fluctuating sex hormones on the outcomes. But what this means is all the recommendations that we've been given may fit for the follicular phase of the cycle or the first half of the menstrual cycle, when estrogen is the primary sex hormone, but they aren't necessarily going to fit for the second half of the menstrual cycle. They're not always going to fit the luteal phase. And the reason for this is that progesterone flips a whole bunch of switches in the body from head to toe, influencing everything ranging from our sleep needs to the meaning of sex in our relationships, to the number of calories that we need every day, to our recovery needs, to the threshold that our brain uses to decide that something is threatening or not threatening. All of those things change as we go into the season of progesterone in the luteal phase. And, and we're not given a guidebook for them. And so we feel terrible because we're not giving our bodies what we need. We don't understand ourselves, and we're not able to communicate with our partners. And the result is it feels pretty terrible, but it doesn't need to based.

A (4:16)

On a woman's cycle. And I know that there are exceptions, okay? And so I know that there are some women that are going to be outside of this box. But for the majority of us, how many days a month do women actually want to have sex?

B (4:28)

On average, what we tend to see is that it really peaks with estrogen across the cycle. And, and so what you find is that they've done this in lots of different ways. So one of my favorite studies, they had married women keeping diaries, and they just had them record whether or not they had sex on a given day. And what you can see Is that there's dramatic convergence with many women having sex on days like 7 to 14 in the cycle. And so usually around day 7 to day 14, you see this linear increase in the number of women who are having sex. And then when you ask women in other studies where they look at the relationship between their sex hormones and the frequency of sexual activity and just their sexual desire, what you find is that estrogen is positively related to sexual desire and also the probability of having sex on a given day. And so during the time in the cycle when estrogen is rising and high, which we see in the first half of the cycle, so the first 14 days of the cycle after progesterone starts getting released, which generally happens right around, let's just say day 15, if we're talking about a 28 day cycle, women's sexual desire really takes a marked decline. And the luteal phase, which is a phase in the cycle when sex cannot lead to conception, is associated with diminished sexual desire, sexual function. And women tend to have less sexual activity.

A (5:44)

So really it's normal for a woman to maybe want to have sex, I mean, really want to have sex only like for a week and a half out of, out of the entire month. Well, I mean, not that we don't other, you know, beyond that, but just really wanting to normal for about that long.

B (6:00)

Yeah. And here's how I would describe it, because I think that what you're, what you're getting at, and I love the way that you describe it about really want it. We call that spontaneous sexual desire. It's the kind of thing where you're just like doing the dishes and all of a sudden you're like, gosh, you know, I just like really want to have some sex. That for women tends to happen right around days like, you know, like I said five or seven to about day 14. And then after that, our sexual desire tends to be more responsive and that is that it tends to respond more to things like a need to connect with our partners. Right. It tends to be more than just the act of sex.

A (6:33)

Right. So that's the having a deep intentional conversation or spending time together. Women are starting to feel like their intimacy levels are being filled up. So that they do want to have sex, Right?

B (6:44)

Absolutely, yes. And so it's just a little bit of a different type of sexual desire that we see in women. And we do tend to see that especially during what we call the fertile window, which is this period of time in the cycle when sex can lead to conception. Again, generally days, eight or nine to day 14 is the fertile window. And this is the time when our sexual desire is the highest. We tend to have the highest amount of spontaneous sexual desire. And then, especially once we go into the luteal phase, sex becomes more about connection. And it's not something where it's just like, oh, my gosh, I just need to have sex instead. It's more of a feeling of I need to feel close to my partner. And that sex is a mechanism by which you can do that.

A (7:23)

And so do men operate most of the time on a spontaneous sex drive?

B (7:27)

Absolutely, yes. Whoa.

A (7:29)

Yeah.

B (7:29)

So men and women have. Yeah, no, men and women. Women have totally different sexual psychology. It's just completely different. And not having an awareness of that means that you're not able to communicate about that. And I think that it causes problems within relationships and it certainly minimizes the possibility of intimacy, because true intimacy, I think, requires being able to have a language to describe what's going on with you and then being able to communicate that effectively with a partner.

A (7:53)

Is it true that men's hormones reset every single day in women's only every month?

B (7:58)

Yes and no. So for men's primary sex hormone, testosterone does reset every day. It has a 24 hour clock and it peaks in the morning. Which if anybody has a male partner that they spoon with in the morning, you know this, right? Their testosterone tends to be highest in the morning and then it decreases as the day goes on. But for women, and women also have testosterone, right? It's not one of our primary sex hormones, but it is a sex hormone we have, and it has the same circadian rhythm within us. It's just that our two primary sex hormones tend to have a cyclical rhythm that goes across the month. And the reason that our sex hormones are different from those of men, men only need to have one sex hormone because they only have one job that their bodies need to do in order to reproduce, and that is have sex. And for a female body, there are two jobs that our bodies have to do. They have to have sex, right? And attract a mate. And that is the domain of our primary sex hormone, estrogen, which is the. Our primary sex hormone during days one to 14 of our cycle, as we're building up to ovulation, and then on the day of ovulation itself, and then we also have to be able to allow for implantation and pregnancy to take place. And that is the domain of our second primary sex hormone, progesterone. Right? And it's orienting our body to be optimized for implantation and for pregnancy, which is why we experience these cycle based shifts is because our body is actually preparing for two distinct sets of activities. Right. The first half of the month is about attraction and it's about sex. The second half of the month is about implantation and about pregnancy. And, and what this means is that the cells of the body from head to toe, including those in the brain, are going to reorganize themselves to be optimized for those two different states. Right? And this means that our bodies need different things during the first half of the month compared to the second half of the month.

A (9:46)

How much of the PMS struggle for women is a result of our environment? You know, our work schedules, our social expectations, even our relationships compared to the actual hormonal changes that occur in the body. Like, is it just our hormones or is it our environment?

B (10:01)

Yes. So both things. You know, when I try to explain like what is PMS and what is responsible for PMS is really three things, right. First is psychological and physical changes that are happening on purpose as your body is reorganizing itself from being optimized for attraction and sex to being optimized for implantation and pregnancy. And just to give an example of this, one of the things that women experience as they transition into the luteal phase is they tend to have greater emotional sensitivity. And this is because our brain actually lowers the threshold on what is considered a threat as a way to stay vigilant and to minimize the possibility of being left during a time that's incredibly vulnerable. Because pregnancy, of course, is an incredibly vulnerable state for women. And so women's smoke detector that's detecting threat within their relationship becomes more sensitive in the second half of the cycle.

A (10:54)

My life has just been explained well, and.

B (10:56)

But knowing that is, I can't tell you how helpful it is to have a language to understand. Explain that to yourself. Like, my brain is more vigilant right now to the possibility of threats within the relationship. Right. And this also allows you to understand that just because it's more vigilant doesn't mean that it's more likely to be correct. It's just more likely to err on the side of caution instead of erring on the side of, you know, missing a threat if there was one. And knowing this and having this language to explain to yourself what's going on and also to be able to communicate with your partner about what you really need is an absolute game changer. Because when you recognize that your br is primed to recognize that there might be a threat to safety and security. You can ask for those things from your partner. You can say, you can ask yourself, am I feeling this way because I'm feeling unsafe or I'm feeling insecure? And if the answer to one of those is yes, then you can communicate with your partner about the thing you actually need, which is reassurance about safety and security instead of fighting about who emptied the dishwasher last, which is usually what these fights tend to look like. Right. And so it actually allows you to get what you want. Right. Another example of some of the intentional changes that happen is the fact that our gut motility slows down because our body is grabbing onto a greater number of nutrients during the second half of the cycle as it's preparing for pregnancy. And this can feel like constipation, or if you're somebody who has ibs, it can worsen symptoms. And so there are some experiences that happen as a part of what the body is doing on purpose. So that's part of what we consider pms. Another part of what we consider PMS is the result of the fact that, that most of us aren't told that our cycles matter for anything other than pregnancy.

A (12:35)

Right?

B (12:35)

Yeah. Right. And so what happens is we're given one size fits all guidelines for what our bodies need that end up having the result of making our bodies rebel. And I'll give you an example of this. I'm willing to bet that nobody's told you that your energy burn. So your calorie needs increase by about 7 to 11% in the second half of the cycle. Right. That means that if you eat 2,000 calories a day, you need just for baseline to maintain your weight and maintain your energy level. You need an additional 140 to 200 calories a day in the second half of the cycle compared to the first. Right. Most women are not told that. I'm guessing you weren't told that. No. And instead you were probably given one size fits all nutritional guidelines that say eat this number of calories every day. So what's going to happen when you're eating the number of calories that you were told to eat and it's not enough and it's not what your body needs. Needs. You're going to get food cravings, you're going to be tired and you're going to be grumpy. Right. And part of the things that we tend to consider PMS are the result of our body being tired, grumpy, and having food cravings because we're not Actually giving our body what it needs during this time because women aren't actually told what their bodies need in the luteal phase. And the third thing is what you were talking about our environment currently. You know, there's so many things, you know, it's like, in some ways, we're living in a really great time. In other ways, we're living in a really terrible time for our hormones. And a lot of the things that we do, I mean, just in terms of our exposure to endocrine disruptors, our lack of social connectedness, so not having social relationships to help buffer stress, chronic stress, you know, too many long hours at our jobs, having our circadian rhythms messed up by the fact that we're exposed to blue light at night by looking at phone screens. All of these things have the effect of eroding our resilience to hormonal changes. And essentially this has the effect of, of making those wild changes in hormones that we get in the second half of the menstrual cycle. Because the hormone changes that happen during the luteal phase are much greater than the ones that happen in the follicular phase or the first half of the cycle. Progesterone levels in the second half of the menstrual cycle peak at levels that are 10 times greater than peak levels of estrogen in the first half of the cycle. So it's just really big changes in hormone. And so many factors of our environment erode at our cellular plasticity, which allows the cells in our body, including our brain cells, to be able to quickly adapt to these hormonal changes. And so when we don't, you know, when we have exposures the way that we all do to chronic stress and not getting enough sleep and everything else, this also makes us more sensitive to hormonal changes, which makes these shifts a little bit less pleasant.

A (15:16)

I have said often that the 9 to 5 is one of the worst things to happen for women. And immediately people are like, here's how women should work. And I' no, I'm not. I obviously work. But what I'm saying is this, like, grueling, bang it out schedule, high stress all the time, no breaks type of workplace environment is not conducive to women's hormones in our cycle. And then some of the women get mad and they're like, well, that's ridiculous and sexist and belittling. And, you know, our period shouldn't matter, our ability to do a job. And I'm like, you're, you're also misunderstanding what I'm saying can you. Do you know what I'm trying to get at? And can you speak to that?

B (15:54)

Right. I think that what you're trying to say is that the world is, was designed with men in mind and that for a man, right? That having the type of work schedules that are demanded on us now, where you're working a million hours a week in a fluorescent lit office and you're not taking time for social connections or if you have a family, you don't have time to be able to do those things that, that might be a suboptimal setup for women compared to men. And I would agree with that. Before people throw tomatoes, let me just say that, you know, we've never thought to question the way that things are designed, but things really in the world, a lot of things are designed for men. You know, it's like medicine is designed for men. It was like based on research that was conducted almost, almost exclusively by men. And the idea that there's anything wrong with female and the female way of being and like what might be optimal for us, the idea that there's something wrong with that to me is just like the result of almost like embodied patriarchy, you know, where it's like, like, like we just have this assumption, right, that if it's male, it's better.

A (17:00)

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B (18:18)

Works.

A (18:19)

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B (19:54)

That.

A (19:54)

That's why I'm like, sounding the alarms on this. And I, and I always bring up, you know, it wasn't people like me who were sounding the alarms. On birth control, originally, it was. It was very, very feminist liberal women who were like, hey, what's going on here? Like, you don't have a birth control insert in here. We're not being disclosed any of the. The side effects or the risks. It wasn't conservative Christian women. So I'm just like, I don't know, it just seems like everything got topsy turvy to me.

B (20:24)

No, I can. I completely agree with you. I couldn't agree with you more. And honestly, I think that we were all fed this idea that the greatest and, like, most feminist thing that we can do in the world is deny our biological differences from men, and that this was somehow going to be the great liberator of all women. And the fact is, it's had the exact opposite effect. And just to give you an example of this, I mean, the whole reason that women feel terrible in the second half of the menstrual cycle in the first place is because we aren't acknowledging that that matters. Right? Like, we've been trying to downplay that hormones matter and that hormonal changes matter. We've been essentially fed this bill of goods that says, you know, denying sex is somehow going to be better for women, but it's been terrible for women. And, like, you see this played out in research all the time. You know, for a really long time, men were the only ones who were studied in medical research. And the reason that researchers were able to get away with doing that was the assumption that women are just smaller versions of men. But then what happens is you have something like, for example, you know, the drug Ambien. And what happened with that? And what happened. What happened with that? So it was made legal. It was. It was legalized by the FDA, I think it was in 1992 or 1993. And what happened soon after it was released on the open market is doctor's offices were getting flooded with calls from women who were having extreme drowsiness. Some women were falling asleep while driving and so getting into car accidents. And they finally went and actually studied it in women, because, of course, it was primarily studied in men. They go and they study it in women. And what did they find? Women metabolize the drug significantly more slowly than men. And so women, two hours after taking the drug, have twice as much of it in their system as a male body does, because men metabolize the drug differently. Men and women are different. We can't just study something in men, apply it to women, you know, make the dose a little bit smaller because women are smaller and then expect it to work the same way. It doesn't work that way. And because of that, what we see is that 8 out of 10 new prescription drugs are pulled from the first year on a market because of. And this regularly happens because of unanticipated side effects in women. 80%. Right. And this is because women aren't being studied in equal numbers. They're not being studied as women, meaning that studying women when their hormones are cycling, instead, they tend to focus their research only on women in the first half of the menstrual cycle, when hormone levels are relatively low. But what this means is that we don't actually know how a woman responds to a drug when her hormone levels are high, which is what women's hormones are about 85% of the time. Denying sex and denying the importance of biological sex is not good for anyone, but it's especially dangerous for women. It hurts us medically, it hurts us in terms of science, it hurts us legally. So just, you know, if you've heard about the reasonable person standard, you know, there's a lot of places that have this as a standard for making a judgment about whether something is considered, for example, sexual harassment or sexual assault. Would a reasonable person consider this to be an act of violence or an act that is threatening? A lot of times this can hurt women. Because if you have a jury filled with reasonable men, men and women tend to be different. There are sex differences that have been replicated and researched several times, showing that men and women have very different beliefs about what's. What is considered threatening when it comes to behaviors. Right. With women seeing a significantly greater number of behaviors as potentially threatening, like somebody, your ex boyfriend driving past your apartment repeatedly at night. Most women see that as threatening. Men don't necessarily see that as threatening. And so if you have a jury filled with reasonable men and they're applying the reasonable person standard to determine whether or not a behavior is stalking, that means that a woman is less likely to be able to get protection against something that's potentially threatening. Right. And so this idea that we can just assume that men and women are the same and that we can just ignore sex differences isn't good for anyone, particularly bad for women.

A (24:20)

And you talked about in your. In your first book, your brain on birth control, how there was a study done where women would go up to men and offer sex.

B (24:32)

Yes.

A (24:33)

Right. Like as a stranger? Like, yes. It was like, hey, would you like to go on a date? Hey, would you like to go to my apartment tonight? Hey, do you Want to go to bed?

B (24:40)

Yes.

A (24:40)

And the men overwhelmingly accepted the bed, like the bed question. They're like, sure, yeah, I just got you.

B (24:47)

Let's, let's go.

A (24:48)

And then the women overwhelmingly said yes to the, to the date proposition because he was like, hey, I've been like following you or watching you and I just think you're so cute. I'd love to go out or whatever. And so the women said yes to that and all of them said no to the sex, right?

B (25:01)

Yes. We have sex differentiated psychology. I mean, it's like men have inherited a brain that historically, you know, would have been rewarded with gene transmission opportunities by having opportunistic or engaging in opportunistic sexual behavior. Women's brains are not wired that way because over the course of evolutionary time, women who are just like, sure, let's get into bed, they could end up with a nine month pregnancy that they have to manage, plus time spent lactating and having no investing partner in order to provide provisioning and protection.

A (25:31)

So, so here's what I don't get, Sarah, and you know more about this than me. If we know that biologically that that's how women behave and how we treat sex, why was the pill marketed to us under this guise of, you are going to be able to have free sex like men, like you've always wanted to, and then you guys will be equal. Was that really the motive for birth control? Was there a different motive for birth control, do you think?

B (25:54)

I think that, like, especially if you look at the history of birth control, I do think that it was essentially trying to allow sex. And my, I have to try to remember the story about it, but I do believe it was actually created by like a, like a Catholic monk.

A (26:08)

And they were essentially, it was somebody, a Catholic person and then another doctor and then Margaret Sanger.

B (26:15)

Yeah, yeah. And so they were essentially trying to allow women to better space the timing of their children in a way that would be natural. And that's why he created this pill, was he was hoping that it would be a form of contraception that was accepted by the church, but then ultimately the church said no. And so then it kind of got thrown out the window. And apparently he was pretty sad about the whole thing because he spent his career building this thing, hoping that it would be acceptable to the church and that it was not. There's a lot to say about the benefits of being able to plan when you're having children. Right. I think that we can agree that the decision of, you know, I want to get an advanced degree, and I am in a relationship or I am married, or I want to be a physician, I want to be a doctor, being able to plan that I'm going to enter into this incredibly laborious educational regimen and, and I can be certain that I'm not going to have a baby during that time and just have it totally sidelined what I'm doing. There's huge benefit to that. And I think that one of the benefits that we've seen with hormonal birth control because it is so effective, has been that it has allowed women to sort of put a stake in the ground and say, I'm going to achieve this. And what we see is that it has allowed women to achieve more than ever before in history just simply because they're able to plan. And I think for a really long time, because pregnancy prevention isn't as sure as it is with something like hormonal birth control. Like if you're using condoms or any other type of a method, the failure rate is higher. It adds a little bit more unpredictability into the model. And I do think it makes it harder for women to make long term goals because they can't feel certain about the fact that they're not going to end up getting benched because of an unexpected pregnancy. And so I think, you know, there's, there's tremendous benefits that have been afforded women from this, but it just hasn't come without a cost. And I think that that's the story that most of us have landed when it came to hormonal birth control. And certainly at the time I wrote this is your brain on birth control, because at that point nobody was asking questions about hormonal birth control. At the time I had the book come out, nobody was questioning the wisdom of birth control. It was very, it was seen as very taboo. And I got a lot of pushback about raising, you know, the issues that are related to changing your hormones. But it really is a big deal. And the degree to which it's a big deal minimized. And it's minimized because, you know, we give it out to girls even when they're just first entering into puberty and just first getting their periods to do everything from, you know, reduce their menstrual cramps and get rid of acne without realizing how serious it is to be shutting down a girl's brain, ovarian axis, shutting down her own hormone production, and then just, you know, giving her this daily dose of these synthetics that don't even perfectly match what her body produces and in totally different levels and totally different pulses. And so her brain and ovaries are never learning to communicate with one another. Right. She's having the effect of having her hormones shut down. And what this does is it changes people.

A (29:15)

Yeah.

B (29:15)

You know, because our hormones are part of what our brain uses to create the experience of being who we are and to give this to people for these minor effects. Without even questioning the wisdom of it. What were we thinking?

A (29:28)

Right. You spent years studying women's brains and hormones. What are some of the most surprising findings from your research when it comes to PMS and the way hormonal shifts affect mood, energy and behavior? I know you talked about a little bit with that, but any other, any like juicy things?

B (29:43)

Well, you know, I, I, I do think that it, it is really interesting. You know, one of the things, and this is also something I touch on in, in the birth control book, this is your brain on birth control. Hormones play a really important role in terms of attraction and regulating sexual activity. And what this means is that like as we talked about, you get changes in sexual desire that occur across the cycle, with women tending to have higher desire and having more frequent sexual activity in the first half of the cycle compared to the second half. But also it influences who we're attracted to and like even what attracts us to our current mates.

A (30:16)

Is it true that on birth control you would be more attracted to a feminine looking man?

B (30:22)

I wouldn't quite frame it that way. The way I would frame it is that the research does seem to show that women de emphasize the priority that they place on masculine type cutes in male faces, voices and behaviors. So just meaning this, that when women are at a point, especially in their cycle, when estrogen is high, this is related to women having a real eye for cues related to testosterone. So women are like, they notice these cues more, so they've done studies of sensory acuity. Women can pick up the scent of testosterone more readily when estrogen is high in the cycle compared to outside of that. They tend to have a heightened preference for masculinity in male faces during this time. And they also have a preference for what I call behavioral masculinity, which is behaviors like social dominance. Right. Things that are sort of assertive types of behaviors that are related to testosterone levels. And so we see that estrogen across the cycle predicts these things. And so when you have women who are on hormonal birth control and estrogen levels are kept really low, it kind of taps the brakes on these preferences and it makes Women's preferences look a little more the way that women's preferences look in the luteal phase of the cycle. Because what we tend to find is that when women are in the second phase of the menstrual cycle, when progesterone is the primary hormone, women shift their attention away from these cues related to sexiness and shift them more toward cues related to investment. So is this somebody who like for example, has a good job, Is this somebody who's going to be a good dad? Right. We tend to prioritize these other types of cues that women also value in their partners. It's just sort of nudging women to place the priority on one set of cues versus another set of cues for naturally cycling woman. So a woman who has a cycle, right. So a non hormonal birth control taking woman, you see the waxing and waning of attraction within relationships. So you'll see that women tend to be most drawn toward these testosterone sort of sexiness cues in the first half of the cycle. Then they tend to be more drawn toward these sort of protection, provisioning, good partnership kinds of qualities in the second half of the cycle. And it's just a nudge because it's not those of us, especially if you're married or you have a long term partner. It's not like you decide you want to change your partners every 14 days. But instead it's like the things that you appreciate about your partner tend to shift a little bit as your attention gets nudged one way or the other. Now when women are on hormonal birth control, they never experience that big boost in estrogen that's related to the preference of sexiness cues. And so what the research finds, and it doesn't find this reliably, so this is one of these things where there's, you know, there's a lot of debate in the literature about this. Although there's no definitive answer on this, there's a lot of research evidence that suggests when women are on hormonal birth control, that this does decrease the emphasis that they place on these cues related to facial masculinity and tends to lead them to be more likely to be emphasizing these other kinds of qualities. There's been studies done, for example, looking at women's ideal male face. And they've had women use computer software to sort of drag a mouse back and forth to make a face more masculinized or more feminized. And they found that when women first did this task, they made a more masculinized face. And then after they started hormonal birth control and were on it for three months, they had them come back into the lab, and those women made a more feminized male face, whereas the control group of women who made a similar face to what they made the first time, which was this slightly less masculinized male face as their ideal male face.

A (34:00)

See, here's my scientific evidence for why this is absolutely true. When I was in high school and I was on birth control, Michael Cera was my celebrity crush. And that really tells you everything you need to know.

B (34:09)

I think I've been doing that. I know. So. Seriously. Well, it's so funny because I have had so many women tell me this story. And so we actually did a study with Natural Cycles, the, you know, the cycle tracking app, and we sent a survey to their users, asking them about whether they chose their partners when they were on hormonal birth control or off of it. And these were all women who are naturally cycling now. So all of them are on. Are cycling at this point, but about half of them chose their partners when they were on the pillow, and the other half did not. The other half chose their partners while they were naturally cycling. And what we found was that the women who chose their partners when they were naturally cycling logged more sexual behavior across the course of several cycles because they're more attracted to their partners. Yeah. And we also asked them questions about, you know, whether or not they felt like their experiences with hormonal birth control, you know, increased, decreased, or led to any change, led to no changes in attraction. And what we found is that some women feel who chose their partners when they were on the pill, when they went off of it, they felt more attracted to their partners. And this is something that happens sometimes because sometimes women just so happen to choose a partner that's really sexy. Right. And then all of a sudden, they go off of the pill, the blinders are off, and they're like, yes, you.

A (35:27)

Have you heard of this women saying to you, sarah, oh, my gosh, I got off the pill. And I am like, I'm not even in love with my husband. I'm not attracted to my husband.

B (35:35)

Yes. No. And I. I know several people who've gone through divorces for this very reason. And it's really sad. I mean, it's really sad that this is something that can happen and that people don't ever talk about it. And the reason that it's so hard to talk about is because, you know, in the eyes of science. Right. Because this isn't the majority Story, right? So like, most women do not go off of hormonal birth control and get a divorce, right? The majority of what happens, and we did a study where we are, we actually like looked at what happens to what proportion of women if they choose their partners on the pill and then they go off of it. And what we found is there's three pots of women, right? You get about 30% who say that they're more attracted to their partner now than ever before. You've got about 40% of women who say, I don't really notice any difference at all. Like, I don't feel more, I don't feel less attracted to my partner. And then you've got another 30% who say I'm less attracted to my partner. Now, the story of science is one where we are oftentimes slaves to the mean, meaning we're slaves to the average. And so if something doesn't influence the average, you know, the average effect that you have from the pill, that they're like, never mind, it doesn't happen, right. And the average effect for going off the pill when you, you know, counterbalance the fact that some women become more attracted to their partners and some become less. And then there's a lot who are sort of in the middle, it looks like there's no difference. Right? But for those 30% of women who chose their partners and now they're no longer attracted to them, it is a big deal.

A (36:58)

And that is like, I guess, worst case scenario.

B (37:02)

That is, you know, that is. And there's a best case scenario, right? There's the best case scenario and then there's the worst case scenario. All of this is information women should have, you know, and it's not like to scare women away from the pill and say, okay, well, just so you know, if you go on this, you're not going to be attracted to your partner and you're probably gonna get a divorce. Because I don't think that that's true. Instead it's like, hey, just so you know, here are some of the possible outcomes that you have to look forward to if you go on hormonal birth control.

A (37:27)

Right now it's giving informed consent.

B (37:29)

Informed.

A (37:29)

Here's the possibilities may not happen, but you should know that there's a possibility.

B (37:33)

Exactly. Because then you know what to look out for. Yeah, right. And you know, like, for example, if you are on it and you're choosing a mate and you don't need to be just go off it for a little while, you know, if. And like, if I was out, like looking for a romantic partner. And I didn't need to be on the pill. I wouldn't be on it, you know, knowing this. But then it, you know, it. It just allows people to actually make the decisions themselves, you know, based on what's important.

A (38:02)

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B (39:20)

Emotional damage.

A (39:22)

I came home, I crawled in my cozy earth sheets. Sheets viscose from bamboo, temperature regulating, silky smooth. And it was like diving into witness protection for your body safe, cool. No judgment, just pure comfort. Cozy Earth has figured it out. These sheets actually help you sleep. Cooler, several degrees, they say. And they're so soft, it's like sleeping inside a lie that you want to believe. This is the kind of comfort money should buy. And listen, if you're skeptical, fine. Get a 100 night sleep trial, 10 year warranty. Try them through the worst heat of the summer. Stop pretending you like crisp sheets. That just means rough. Get cozy, get sane. Go to cozyearth.com use code Alex for 40 off. Cozyearth.com code Alex for 40 off. What would you tell men if you could only tell them one thing about women on the week before their period?

B (40:10)

Besides, I'm sorry.

A (40:14)

That works.

B (40:15)

I mean, no, honestly, I would. I want to tell them two things. So the two things I want to say is, one is that it does change your, your threshold for detecting a threat. Right. And so just to understand that safety and security are going to be primary concerns of your partners during this time. Right. And if you notice that your partner is acting off. Right. In a way because of something that happened, to be able to communicate with your partner about that and say, are you feeling unsafe? Are you feeling insecure? Because a lot of times when women are feeling upset about something in the relationship, particularly in the second half of the menstrual cycle, ultimately it boils down to those two issues, safety, security. So knowing what question to ask and then being able to address it, I think will lead to better resolution within the relationship. So that's the first thing. The second thing I would tell men is that sexual desire is cyclical. I can't tell you the number of men that I've gotten emails from. It just even when my first book came out, which just spent, I don't know, maybe a page and a half talking about women's sexual desire and how it changes across the cycle. And I've gotten these emails from men saying, oh my goodness, thank you. Like, I thought that we had a problem in our relationship or I thought my partner wasn't attracted to me. And it's because we have these, you know, one size fits all ideas about what human sexuality looks like that are based on men. And the fact is women are cyclical. And when men know that, it takes so much pressure off them because a lot of them, if they're feeling a lack of sexual affection from their partner, they think that there's something wrong with them. Right. So they feel like their partner might not be attracted to them or they think there might be something wrong with the relationship. You also get this problem with women who aren't told about this and they are experiencing a low libido in the second half of the cycle and they think that there's something wrong with them or something wrong with the relationship. And I can't tell you how much pressure it takes off the relationship relationship to understand the cyclicity of desire and to be able to communicate about it, because it really does allow people to stop being defensive within their relationship. Because anytime that you have what feels like a Potential issue when it comes to sex, it's a very vulnerable issue for people.

A (42:26)

So we should have these slight changes throughout the month. But what we shouldn't have is extremes. So if you've got a woman interludial phase, you know, the week or so before a period and she is like off the rails, like having meltdowns and just out of control during this time, how can those women regain a sense of clarity and, and just some self compassion?

B (42:49)

So two things. So one is if you feel, if you're a woman or you're a man, you have a female partner and, and during the last week or so of the cycle, like you're just losing your mind or she's losing her mind. I would consider the possibility that this is pmdd, which is an actual clinical diagnosis. And this is where you get mood changes and irritability that not only feel unpleasant, but they actually end up kind of ruining your life. Right. And a lot of times this can be associated with suicidal ideation. Like a lot of women who have PMDD like report that they, you know, think about self harm and, and if this describes you, you should go and get. There's these really wonderful resources at the International association for Menstrual Disorder. They have like charts you can download for free that'll allow you to chart your symptoms. Because anytime that you try to get a diagnosis for pmdd, they're going to ask you for two months worth of charting data. So if you think that you have an issue with this, go download that now and start tracking right now and then make the doctor's appointment. Because if you go in with the chart, it's going to speed up the diagnosis and then that's going to increase your ability to be able to find a solution. And there's a, there's lots of solutions, both pharmacological and not pharmacological, if you're looking to stay away from those things. But if you are somebody who you know can get kind of gnarly pms, but you don't think it's pmdd, it's not disrupting your life, but it just makes you feel not great. I would recommend taking some of the steps that I talk about in the book about ways that you can increase your resilience to hormonal changes. Because a lot of us, especially in western society where we have these incredibly stressful jobs, we don't get regular exposure to sunlight, where we don't invest in building community around us, all of these things that help to minimize inflammatory activity in the body and help to promote cellular plasticity and allow us to move between the cycles without experiencing terrible psychological turbulence. There's a lot of things that you can do to improve these types of symptoms and a lot of them are, are kind of obvious, right? It's like, like processed foods, like probably not a great idea that's going to increase inflammatory activity in the body. And anything that you do that increases inflammation is going to erode cellular plasticity and make the changes that you experience across the cycle a lot more noticeable and not in a pleasant way. So taking some of the steps I talk about in the book about ways to increase your plasticity and your, your resilience to hormonal changes, we'll take what for some women can feel like driving up, you know, a mountainside and then driving off a cliff and just make it feel more like coasting along a hill. Because as our hormones change, we do change and you're going to feel that it doesn't need to feel terrible.

A (45:32)

And also one thing too that I think is important and I know that people, especially moms, are going to say, well, this isn't realistic at this time of my life. And that's okay, ideally, and maybe these are times that your partner can step in and kind of leave you for a minute. But certain points of our cycle, we need more sleep than others.

B (45:50)

Yes, 100.

A (45:51)

So like when I'm the week before my period, I notice myself, I am getting tired earlier. Like I could literally go to bed for the night at 8:30 and then sleep till 7 and I need that. And then at other phases of my cycle, I could go to bed at 10 and wake up at 5 and feel great. You know, it just totally depends. Overall, women need more sleep than men to be able to function correctly. But especially at different points of our cycle.

B (46:15)

Oh yes, no 100%, our body is working harder. I mean, you know, our body temperature increases by almost a full degree. Our calorie burn increases, our respiration rate increases, so our heart is going faster, we're breathing more deeply, our bodies are working harder during this time and we do need more sleep. It's like there's so many things that our bodies are doing as we transition in the second half of the menstrual cycle that we just don't pay any attention to. And the result is that we feel terrible and including the lack of extra sleep. And I think that your idea is a really good one because about talking to your partner and seeing whether or not if you're married or you have a partner and you've got kids and everything else. See if you can swap where you go to bed early on this week or that week. And then you'll take the extra childcare during the times when you have more energy and your sleep needs aren't as great. Great, because I think that being able to build into our lives, you know, time to take care of ourselves the way that our bodies need to be taken care of, can be incredibly helpful. And it can, like, it can do a lot more than people think that it will, you know, because it seems like, oh, more sleep. Like that. Okay, sure. You know, like, yeah, that's really going to do it. But it really does. It makes a big difference.

A (47:28)

So PMS is not inevitable?

B (47:29)

No, no. You're going to feel different in the second two weeks of the cycle than the first two weeks, two weeks of the cycle, because you've got two different hormones who do two totally different jobs in the body. Right. So you're going to feel a little bit different, but it can feel more like, like, you know, day and later that day instead of, like day and.

A (47:46)

Night, you know, and that means you're healthy and that things are working the way they're supposed to.

B (47:50)

Exactly, yes. And if you're feeling not the way that you want to feel, like I say, I. I really recommend taking some of the steps that I talk about in the book to try to increase your resilience to hormonal changes, because it really does make a big difference. And I even give, you know, some examples of things that you can do if you feel like your whole life is upside down and that, you know, that you're not taking good care of your body and that your body is not in good physical health. Just some really easy first steps that you can take to try to improve your resilience to hormonal changes, including even just, you know, instead of having your morning coffee inside, take it outside where you can get morning sunlight in your eyes to help decrease melatonin production, wake you up, and it will also help help set your circadian clock. And our cycles and our hormones are set based on our circadian rhythm.

A (48:36)

It's all about the circadian rhythm. You guys, we talked about this.

B (48:39)

Yeah, no, it is, it is. And. And so even just the small step of taking your morning coffee routine outside, that is like a really powerful first step in starting to move toward a lifestyle that helps to support your resilience to hormonal changes.

A (48:54)

Why don't diet and fitness plans ever mention that women's brains and, and hormones Literally change every month because almost all.

B (49:01)

Of the research is conducted on men. And so like when you look at kinesiology and nutrition, the fields studied primarily, like if you look at the pre clinical research, which studies, you know, animal models first is done on males and over rectomized females, so females whose ovaries are taken out so they can't produce hormones. And then in, in human subjects, it's studied in men or women in the very early days of their menstrual cycle, never accounting for the fact that our hormones cycle and that our needs are going to change. And so all that these people who give us these recommendations have ever been taught, it's what's desirable and what's best for men. And so it's only recently that we've started to see a shift with some people starting to put together programs that are optimized for different phases of the cycle, including the app 28, which we've spent some time talking about off camera.

A (49:52)

The founders of Ed magazine launched 28 and they're good friends of mine in the show and they know Sarah and they're friends with Sarah. And that's an app I always, always recommend just because I think you guys did such a great job going into more of these things that other places are not talking about. What workouts are best right now. What should your grocery list look like this time of your cycle? What meals could you make some recipe ideas for this week of your cycle? I. It's so, it touches all of the bases and it's also just beautifully done.

B (50:25)

It's so pretty. Yeah, it's so pretty. And like the food is good. Like that's the other thing is it's not just like, okay, you know, some salmon and some salt and some broccoli and you're like, I don't want to eat this. Yeah. But it's like these really beautiful recipes made by these nutritionists who just do a really fantastic job. Just the aesthetic of it is gorgeous and it's just a really nice app. And the best part is like based in science.

A (50:45)

Right.

B (50:46)

Because I do think that there's a lot out there and like you'll hear some kind of woo woo things about, you know, what works and doesn't work depending on cycle phase. And some of it is grounded in science. So I'm not like, I'm not throwing shades, but there is some stuff that's out there that is a little bit not weird. Yeah. Not not so sciency is data showing.

A (51:05)

Right now that more women are getting off the pill. That they're getting on the pill or has it pretty much stayed the same?

B (51:11)

You know, it's really interesting because it, the pill uses decreased a little bit. Like, so we generally see that it's decreased, but more women are using the hormonal IUD than ever before. And so this is something that ultimately acts very similarly to the hormonal birth control control. But women aren't told about that.

A (51:31)

What is the lie that women are told about the iud?

B (51:33)

Oh my gosh, here's the lie. It acts locally, all right? So doctors will say, oh, don't worry about the hormonal iud. Those hormones act locally. You heard it here first. There's no such thing as a locally acting hormone. All right? Hormones, when they get in the body, they travel in the bloodstream and they go everywhere that blood goes. And the last I checked, that's everywhere in the body. Right? And that means that when you have hormones in the hormonal iud, it goes everywhere, including your brain. And this is the reason that when women start the hormonal iud, most of them don't ovulate. Ovulation starts in the brain. And the only reason that the brain would not be telling the ovaries to ovulate is because it's getting some of the progestin, that synthetic progesterone that's in the iud, and it's being picked up by the receptors in the brain. And so there's no way it acts locally because there's no such thing as a locally acting hormone. And we can see evidence of that by the fact that most of the women aren't ovulating when they're first on. This is crazy. It is crazy. Now, the thing that makes the IUD kind of a complicated case is that I said most women don't ovulate when they're on it when they're first have the IUD put in. But some women do. So some women, even though the hormones are being released and we know that they're systemic because there's no way to have a non systemic hormone. It's just impossible. It just violates the law of hormones. For whatever reason, their brain is like, eh, that's fine, I'm gonna go ahead and ovulate anyway. And those women probably actually feel pretty good when they're on the hormonal iud, because when you're cycling and producing sex hormones, most women feel pretty good. Yeah. And so. So for those women who continue to ovulate while on the hormonal iud, they have one set of side effects which is going to be relatively minimal. But then you have. For women who are not ovulating, which is the majority of them, especially when they first have it in, you tend to have a lot of side effects because they're not ovulating, they're not producing sex hormones.

A (53:20)

What sort of side effects?

B (53:21)

All of the things I talk about, and this is your brain on birth control. You know, you can get changes in partner attraction, you can get changes in, in sexual desire, you can get changes in who you're attracted to. There's also been studies showing clitoral shrinkage on the hormonal IUD because it doesn't have estrogen in it. It only has synthetic progesterone, progestin. And you're not producing any estrogen because you're not ovulating. And so when your estrogen starts to shrink up, so too does, so too does the clitoris.

A (53:46)

Holy crap.

B (53:47)

I know, it's like, no, you don't like, you know, people don't talk about this stuff, but this like, it happens happens.

A (53:52)

One question I get all the time is, what about the copper iud? Is that somehow better if I am wanting to be on birth control, but I'm wary of hormonal birth controls? Copper IUD better somehow?

B (54:01)

Yeah. So I, I think it is and I'm gonna have a big, huge asterisk after that. Okay. So I think it is because it doesn't, it doesn't affect your hormones, right? You still ovulate. So when women are on the copper iud, they do ovulate, it does cause an inflammatory event in the like uterus, cervix area. And for women who are sensitive to, to inflammation, like inflammatory factors, it can lead even that to mental health related side effects. Which sounds crazy. The idea that you take in this thing that doesn't release hormones and that it can cause mental health issues and many doctors aren't aware of this. And so they'll tell you that you're crazy if you're having mental health side effects from the copper iud. But they are possible, they're just rare. Other thing I don't like about the copper IUD is that it, it hurts, hurts. I mean, it's really painful for girls when they get this put in and you get worse. Menstrual cramping initially and, and for a pretty long time. And so I don't love it for that reason because it's not very pleasant for women. And there have been some reports of copper toxicity, although I'LL say that the science on that isn't great. Like, most of the science supports the idea that for most women it does not cause copper toxicity. But that doesn't mean it doesn't happen for some women. Like, as I noted earlier, you know, one of the issues that we have in science is that we are slaves to the mean, right? And so if something doesn't happen on average, we just say, oh, no, that doesn't happen. But sometimes it does happen, right? It's just that for some, some people it causes problems and other people it doesn't, and you're not seeing mean differences. And so I do believe the women who say that they've experienced this, because some women will say, I got, you know, severe, like really high levels of copper and it created all these side effects. And I don't deny those. I, I don't, I don't think that those women are making that up. I think that that can happen. It's just science doesn't have a whole lot to say about it just yet.

A (55:43)

This is a basic question, but so many women are too embarrassed to ask it. How do you track your cycle?

B (55:49)

If you just want to do like a simple cycle tracking, easiest way to do it. And, and, and this is really the, the sort of starting point for any type of cycle tracking that you might do. The first day of your cycle is the day you start your period. So that's day one. And that's easy for all of us to identify, right? We all know when our period starts. And then it's just a matter of if all you're doing is counting your cycle and seeing how many days it is. You just wait until you get another period and then you know how long your cycle is, right? You're like, okay, I had 28 days between the time I started my first period and the time I started my second period. There's 28 days, if you actually want to track it and try to figure out what phase of the menstrual cycle you're in and like, whether or not pregnancy, pregnancy as possible from sex, that's when you're going to want to do something like, I use the aura ring, but you can use any other, you know, type of a tracking device. And this is sort of like next step. And so the next step would be if you take something like this or you just take your daily temperature. If you write down your temperature every day, what you'll notice is that right prior to ovulation, you get a tiny dip in temperature. It's usually like 0.01 or like 0.1 degrees is very small. You get a little bit of a decrease in temperature. And then as soon as, as soon as progesterone starts getting released and you enter into the luteal phase, you get a body temperature increase and it increases by almost a full degree. And so it's very noticeable. And so if you look at, because like I said, I use the Oura ring, so it's like really easy for me where it'll show the line where my average temperature is. And then it's like below the line is where I am when I'm in the follicular phase. And after I ovulate, it's all above the line. And so that's really easy for me to see where I am in the cycle. If you use a tracking app like something like 28 wellness, their, their tracking app, or you use something like Flow or use something like Natural Cycles, they will also take that information in and be able to provide you with information about when you're in the fertile window. And the fertile window is when some sex can lead to conception. And this is something that occurs usually about five days prior to ovulation. And so for most women, if you have like a 28 day cycle, which is a textbook menstrual cycle, ovulation generally happens around day 14, so about two weeks in. And so it would be that five days prior. So like day nine through day 14 would be the days where sex could lead to conception. If you want to go another step further, you can get into full on fertility awareness. And this is where women will do things like track their body temperature. They'll also track their cervical position, which is something that you can feel by just getting really comfortable with yourself and putting your fingers in your vagina and tapping on your cervix because normally it feels it's like high and tight. And that generally means you're outside of your fertile window. And when you're in your fertile window, it drops a little bit lower and it gets soft. And you also get the appearance of what they call fertile mucus, which feels like it's like egg whites instead of being like either creamy, which is generally like luteal phase types of cervical mucus, or just sort of watery, which is early follicular phase types of cervical mucus. So you know you can, you can go all the way from one side where you're just counting. Right. So first day to first day, all the way down to sticking your hands up your vagina.

A (59:03)

Yeah, you pick.

B (59:04)

And anything in between. And so, you know, everybody's got their preferred way of doing things, and it depends on what your goals are. And, like, are you trying to avoid getting pregnant? I mean, obviously for those women, you need to do things that are going to be more intensive than just counting days on the calendar. But for many women who aren't using it as a means of fertility regulation, I find that just even using the aura ring is, like, just really helpful because I know exactly what's happening.

A (59:28)

Yeah. And you can wear. Because I know my audience is gonna be like, what about EMFs? You can wear the oura ring on airplane mode. So it'll collect your data all day long. Even on airplane mode, you have to worry about any Bluetooth. Nothing. At the end of the day, you can just turn your Bluetooth on for a second. It'll sync all your data to your app. You can read what happened during the day, turn it back on airplane mode to go to bed. It is so easy.

B (59:48)

It is so easy. Yes. And if you want to get another, like, really, like something like mirror fertility monitor that allows you to actually look at your hormone levels every day. Oh, cool. And it's very cool. And you can do it at home and it plots it in an app in, like this really nice, beautiful way. And so this is something especially for women who are either trying to. Trying to conceive or trying not to conceive. This is a really good way to be able to actually see what's happening hormonally.

A (60:10)

Are doctors gaslighting women when they tell them that the hormonal birth control does not cause them to gain weight?

B (60:16)

Yes and no. So, but yeah, but mostly yes. So my answer is yes and no. But mostly yes. So here's the deal. The party line, based on the majority of research says, oh, no, hormonal birth control does not, you know, cause waking up gain. Like the fine print on that answer is, well, it's different depending on which type of hormonal birth control you're on. And it differs depending on the woman. Okay, so here's what the other research finds. Some forms of hormonal birth control, especially progestin only products. So, like, the birth control shot is the worst offender, but also the progestin only pill, which is the one that's now available over the counter. These tend to have a greater risk of weight gain than do the combined oral contraceptive pills, which are the general, you know, birth control pills on the market. The one that has the worst effects with weight gain is the hormonal birth Control shot, the one that they're now also finding is linked with these brain tumors. Oh, my God. So, yeah, no, it's like, not a good side effect profile on that one. I would not recommend that one to anyone, honestly. And I don't tend to hate on most forms of. I'm always like, whatever you want to do. Except that one is just like, I wouldn't go on it. The other thing is there is research because after, you know, women have been saying forever, I gained weight on the birth control pill, and their doctor's like, no, no, no, no, no. Some researchers went and reanalyzed data from some of these studies that found no differences in, you know, weight gain depending on whether you were put on birth control or not. Because even doing this experimentally. And then they divided the data depending on women's starting body weight weight, and what they found was that for some women, it actually does lead to weight gain. It's just that for other women, it leads to weight loss. And the effect is it looks like nothing happens. And so what the research finds is that if you start out with a low body weight, not meaning lower than what's healthy, just on average, you're, you know, have lower body weight. Like, you would be lower. I would be lower. Right. For just people who on average have lower body weight. Women who have lower body weight tend to gain weight when they go on hormonal birth control. And women who start out with a heavier body weight, they tend to lose weight when they go on hormonal birth control. And so there's been some re analysis of the data. And so there is not like, a clear answer. Like, there's no, like, one size fits all answer. Like, don't go on birth controls and make you gain weight. But instead it may contribute to weight gain just depending potentially on your starting body weight.

A (62:42)

All right, Right, Listen, my buddy calls me the other day and says I'm booking a flight to Turkey for hair surgery. I'm like, why are you throwing your life savings at a scalpel when the solution has been hanging over your head for 10 minutes a day? Get a juve. That's j O O V Red light therapy. I use it daily. Ten minutes. Morning, evening.

B (63:00)

Boom.

A (63:00)

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B (63:57)

Got the wrong stall.

A (63:59)

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B (65:03)

Well, with that, you know, there's a lot of different research lines that are converging onto what that answer is. And the one that's most well studied is changes in GABAergic activity, which is a terrible sounding word. But GABA is your brain's primary inhibitory neurotransmitter system. When you have GABA activity in the brain, it slows the brain down and calms you down, down. And so just to give you examples of things that make GABA get released in your brain Meditating, sitting by a fireplace in your favorite sweatpants, drinking a glass of wine. Right. Alcohol actually stimulates your GABA receptors. And that calm feeling that many people get where it feels like everything's kind of relaxing, that's GABA activity right there in your brain. One of the most potent activators of GABA receptors in our brain is a metabolic byproduct of the sex hormone progesterone. Right. And progesterone, of course, gets released by a woman when she's cycling in the luteal phase of the cycle, which is why oftentimes, during the last two weeks of the menstrual cycle, women tend to feel a little bit sleepier and less motivated and less energetic. Is in part because this metabolite of progesterone, called allopregnanolone, it stimulates GABA receptors, slows the brain down, and makes women feel a little bit more, you know, flatlined. Even though GABA is something that slows the brain down, which might sound like it's something that's, like, bad, is actually really good in helping maintain and stabilize mood. And what happens with hormonal birth control is these synthetic forms of progesterone that are in hormonal birth control. Progestins, they're not made out of progesterone, and they're not biologically identical to progesterone. Most of them are synthesized out of testosterone. And so when they get metabolized in the body, they don't release allopregnanoline. So there's no calming activity of the brain that women's brains are historically used to getting. And this may be potentially contributing to some of the mental health related side effects that we see with hormonal birth control. And there are mental health side effects with hormonal birth control. You know, when you use hormonal birth control, it is related to a heightened risk of developing depression and developing anxiety relative to what is observed in women who are naturally cycling. And now there's new research that suggests that when you give women hormonal birth control before their brains are done developing. So when you give it to teenagers, that it may have lasting impact on their probability of developing major depressive disorder throughout their lifetime, even after they go off of it.

A (67:36)

Oh, my gosh.

B (67:37)

I know. And is anybody communicating this to women or girls? No, it's really crazy. And then these girls, these young girls are being put on hormonal birth control for things like acne or cramps with nobody communicating to them that, okay, now this might be Your solution for acne and for cramps. But just so you know, there's a probability, you know, this is going to increase your risk of developing depression throughout your lifetime. I think most people would try to figure out a different solution, of course, but this isn't being communicated. And to me, I think it's criminal. Almost nobody is looking at this as a research topic. I've only seen, seen a handful of studies that have actually asked the question, what happens to a developing brain when you shut down the ovaries and give it hormonal birth control. But the studies that have been done are all pointing in the same direction and it suggests that it may have a lasting negative impact on mental health.

A (68:26)

Tell us a story of the strippers who were ovulating versus those that weren't.

B (68:31)

This is like why you go into science, folks. Like, it's like to be able to talk about things like this and not have people give you a dirty look and instead, like, ask for the citation. So this is, was a study that, and it was so clever, where researchers were just really interested in learning more about the role of hormones, women's sex hormones, on mate attraction. And they were really particularly interested in whether estrogen, when it's rising across the cycle, specifically because it's related to the time in the cycle when sex can lead to conception. Like, might men find women particularly desirable during this time? Right. Because given that sex can lead to conception, if it were true that men just so happened to find those women, like, near high fertility, most attractive, they would have passed down a lot more of their genes than men who couldn't, you know, tell the difference between a woman who's at high fertility compared to low. So the way, the way that they decided to study this was to follow a bunch of strippers in a strip club to see how much money they were earning depending on where they were in the cycle and whether or not they were using hormonal birth control or not. And what their prediction was was that for women who are naturally cycling again, women who cycle between estrogen, that attraction and sex hormone, and then progesterone, the pregnancy and implantation hormone, that women would earn more money and be sexier to their male clients. Right. When estrogen is peaking across the cycle. Right. When sex can lead to conception. And then they predicted that for women who are using hormonal birth control. Right. Who don't ovulate. Right. And have the same daily hormonal message, which is one of relatively low levels of estrogen and a higher level of, of progestin that synthetic progesterone, that they would have lower and more stable TIP earnings across the month. And that's exactly what they found.

A (70:15)

Oh, my gosh.

B (70:16)

What they found. They followed the women for two cycles and they had them track how many hours they worked and they had them track how much tip money they made. And then they looked at, they normalized the data on to a 28 day cycle. They mapped how much they made depending on whether they were cycling or whether they were on hormonal birth control. What they found was that for the naturally cycling women, they earned significantly higher tip earnings when fertility is high in the cycle. So when estrogen is high, generally around days 9 to 14 of the cycle, is when they were earning the most money. And then it would start to decrease a little bit. And that for when women who are using hormonal birth control, it was lower and flatter across the cycle.

A (70:55)

That is wild.

B (70:56)

It is wild. And it suggests that men are picking up on this. And again, not in a way where a man is like, wow, I bet, you know, I bet she's obviously stimulating. Like, I bet she's fertile.

A (71:04)

They don't even know they're doing.

B (71:05)

No, they don't. They're just like, wow.

A (71:06)

Chemistry in the air.

B (71:07)

Yeah. But they're just like, wow, like she is really sexy. And it's just something about her. Right. That makes them want to open their heart and their wallet. Right. To this girl.

A (71:18)

When we raised a generation of women on the birth control pill, did we raise a generation of women who don't feel fully alive?

B (71:25)

You know, that's a really interesting question. And I think that for at least some women, I think that that's very true. I mean, I. It just my own own experiences. And I would never have answered this question this way when I was on it, by the way, because this is one of these things. I was on it for over a decade. And when I was on it, if you asked me this question, I'd be like, I feel great. Like, are you kidding me? Like, I feel amazing. Like, you don't know what you're talking about. That's dumb.

A (71:49)

You don't know until you're off.

B (71:50)

No. And then you're off of it. And then it was about three months later and I was just like, what was I missing? Like, oh my gosh. Like, I just felt so much more alive and I just. Everything had so much more dimension and amplitude. It was like, you know, I felt things more deeply. I felt sexually alive again in a way that I hadn't I thought I'd outgrown, you know, I thought, oh, you know, I've outgrown all of that. I was like, 30. You know, it's like, you don't outgrow that at 30. I just felt more alive, like. Like my emotions felt deeper things felt more meaningful. I felt more excitement. This is the craziest thing. And I've heard it from other women now, too. But, like, I started going to the gym again, and I was, like, downloading new music for the first time in, like, 10 years. I was, like, downloading. I was just like. I couldn't get of, like, sensation, you know, it was like new songs and, like, I was trying new foods and I was going to the gym. I mean, it was just like this total, you know, opening of my eyes that I never would have experienced, you know, if I hadn't have gone off of it. And I didn't know I was missing it when I was on it, because you don't notice it when it's changing you. You know, I just think that over time, you just get used to this, like, sort of, you know, just kind of stagnant. Yeah. Well, it's almost like. Like erosion. Like. Like with sand. You know, where you have a rock, rock, and then water is, like, wearing against it and it turns into sand and the rock doesn't notice. It's just like, you know, 10 years later, it's sand. Yeah. And I kind of feel like that was me. And then all of a sudden, you know, I went off of it and over, like I said, it took about three months after being off of it, and I was just like. I felt so different.

A (73:17)

You were like, hi, nice to meet me.

B (73:19)

Yeah, I know. Like, this is great. What was really funny was that it was like, it was not even nice to meet you. It's, like, so great to see you again because I remembered that person from who I used to be, and I thought that I had outgrown her.

A (73:32)

Is there any scientific evidence whatsoever that being on the pill could change your sexual orientation?

B (73:40)

So that's interesting. So there's no research on that. Okay. So there's zero. But I have gotten emails from women who have had this happen. And I'm not going to say that, like, because obviously we don't know for sure that the birth control pill caused that.

A (73:52)

Right.

B (73:52)

But, you know, so here's. Here's what we know, and here's what I've heard. Okay. What we know is that. That sex hormones play a role in sexual orientation. They just do. Right? Another thing that we know is that sexual orientation lives on a normal distribution, meaning that you can have people who are super heterosexual and then you have people who are super non heterosexual, and you've got kind of everything in between, all right? And everybody, you know, has a place that they fall, okay? And you can have people who are, you know, because of a hormonal change, who are kind of on the edge of being bisexual or not, who can get nudged and pushed in one direction or the other. And those are the experiences that I've heard from people saying, like, I thought I was bisexual and then I went off the birth control pill and now I only like men. Or I've also heard the opposite. I thought I was bisexual, and then I went off the birth control pill, and now I only like women. I've also heard, heard I thought I only liked women, and now, I mean, so I've heard all of it, okay? I've heard every different pairing that you could possibly have where they went on or off of it, and it nudged them either into or away from bisexuality. It never has been something where it was like, I was an obligatory heterosexual. And that just means that you're only attracted to members of, of the other sex, right? This is like most people. So like, I, you know, you don't all of a sudden then take the birth control pill and end up being an obligatory lesbian. Right? What tends to happen is as people whose sexuality tends to fall a little bit toward the middle of the continuum anyway, and then it kind of nudges them because hormones don't have sledgehammer effects. They have nudging effects. They kind of nudge you this way or nudge you that way. And, and I have heard from people who, according to them, you know, have had the experience of having their sexuality nudged in one way or the other. And I even have one of my former graduate students, and this, this one wasn't so much about her sexual orientation, but instead it was like. And it wasn't even necessarily her gender identity, but she said, like, whenever she's on the birth control pill, she's. She feels more androgynous and she always cuts her hair. And so we always would know when she was on or off of the pill because she would go on it and off of it, depending on what the relationships that she was in. Because she would cut her hair short and start wearing pants all the time. And when she is not, when she's cycling, she grows her hair longer and tends to wear a combination of, like, dresses and pants. Do I believe that it's possible. 100 I believe it's possible. And do I believe that these people experiences are real? Yes, I do. And so I do think that it's something that can happen. Do I think it usually happens? No. I just think that it's these special cases where you have people who just happen to fall at a pivot point in their sexual orientation or gender identity where they just get nudged one way or the other.

A (76:26)

What happens to men's hormones when they're single versus married and becoming dads?

B (76:32)

This is like so cool. I love this research. And so what it finds and you know, I love this research because. Because culturally there's this narrative that men should always have their foot on the gas of the testosterone pedal or else they're just not manly enough. And that's why you see testosterone clinics on every corner. And that's just not true. So the male body is actually made to press and then let the gas off the petal of testosterone, depending on the wisdom of exerting what we call mating effort. Effort. Right. So mating effort is just anything that you're doing in the service of attracting mates, including looking at mates and being sexually open to the idea of alternative mates and everything else. And we know that testosterone is related to, you know, sexual drive. We know it's related to a greater probability of having a greater number of sexual partners and so on and so forth. And what we find is that when men get in long term relationships, they take their foot off the gas pedal of testosterone a little bit. So testosterone levels fall down a little bit when men get into long term relationships. And then when men have children, they let off the gas a little bit further. And men's testosterone levels decrease even further once the children start to leave the home. And all of this is just. Is statistically controlling for age because men's testosterone does decrease over time. Okay. And that's just one of those things that is unavoidable. All right? So controlling for the fact that testosterone is going to be decreasing over time anyway, when men's children leave the home, their testosterone will go up a little bit bit. If men get divorced, their testosterone will go up again. And essentially it's just rising and falling based on the wisdom of investing effort in mating effort compared to either relationship maintenance or childcare effort. Because you can't spend a calorie twice. Right? We only have so many hours in the day. And time that you spend doing one thing like reading Goodnight Moon to a child. Right. Or giving them a bath is time that you can't spend on other things like going out in a traffic, attracting partners. Right. And so we always have to make trade offs. And testosterone is one of the things that helps men's brains make these types of motivational trade offs.

A (78:37)

Yeah, so what you're saying is bar wench or old lady whispering hush.

B (78:44)

What will it be? It's so cool though, because, you know, it's like men's hormones affect men, women's hormones affect women. And there's nothing dangerous about these ideas. This is like the brilliant design of the human body is that we listen, our brains listen to our hormones and our hormones are orienting us toward different goal states. And again, you know, with women with estrogen, it's attraction and sex. And then with progesterone, it's implantation and pregnancy. And for men, when testosterone is high, it's more about mating effort. When testosterone is lowered, it's more about parenting effort and relationship maintenance effort. And all of this is part of how the mechanics of the brain work, you know, and it's a really beautiful thing. And so, yeah, I think that sometimes hormones get a bad rap or the idea that we're hormonal gets a bad rap. But it's like actually really smart. Like I'm happily hormonal and men are happily. You know, men should be happily hormonal too, because they're just as hormonal as we are. They just have different hormones.

A (79:34)

What do you hope the conversation around women's cycles looks like in the future and women's hormones and how women can start advocating for ourselves when it comes to our hormonal health?

B (79:44)

I mean, I think that just understanding the way that cycles work is like incredibly important. And understanding that we have two hormones instead of one, and that the way that our bodies are going to orient, orient themselves and the way our brains are going to orient themselves are going to be influenced by our changing sex hormones. Ideally, you know, well, one, just having the conversations with our daughters and with our friends and with other people and just having this be something that is just an open part of a discussion where everybody knows how it works, I think is a really good step. But like to me, understanding all of this, the, the what makes that so powerful is that moving forward, my hope is that we're going to be able to give women guidance about what their bodies actually need when it comes to sleep, nutrition, you know, connection within their relationships, medical care that is tailored to their hormones. Because the fact is, you know, when you have something like estrogen and progesterone, and they flip all these switches in the body. That means that the way that you metabolize drugs and the way that you experience symptoms of chronic disease and everything are going to shift across the cycle. And there's evidence that suggests that it does. Like, so, for example, women who have asthma, women who have adhd, women who have major depressive disorder. A lot of these women experience premenstrual exacerbations, meaning that their symptoms get worse in the second half of the cycle compared to the first. One of the reasons that the symptoms get worse is that they're not getting good symptom control because the way that their bodies respond to drugs are likely different across the cycle. Knowing what our hormonal changes are doing in our body, being able to tailor nutrition, medical guidance, etc, depending on what's happening hormonally, I think that's really going to be the next step in terms of moving women's health forward and just like changing the way that we think about, think about women's bodies.

A (81:28)

Everyone needs to read your brain on birth control if you haven't yet, but I know a lot of you have. And then you also have this new book, the Period Brain the New Science of why We PMS and How to Fix It. Obviously ladies, we have to read this, but you should also have your husband, especially if he is into health and science nonfiction. You should have your husband read this or your boyfriend read this because it is so eye opening. So can you tell us a little bit about this book and where to get it?

B (81:54)

Yeah, you can get this book anywhere that books are sold. You can order it on Amazon, you can get it at your favorite indie bookstore, or order it from your favorite indie bookstore if you don't want to make the drive. So you can find it anywhere books are sold, you can also find it. I have it on my website and it's linked to buy links there. And my website is Sara E. Hill.com and that's Sarah with an H. I'll tell you this, the men who have read this book, like their minds are blown and they feel like they've got the keys to the kingdom because honestly, it really gives you a new insight into women. And not in a way that's like predatory, right? Like, oh, well, now you can exploit women because you want to. But instead most men that I know anyway really love the women in their lives and they want to be able to support them. And this is a really an opportunity to start conversations to really deepen the intimacy of the relationship. It talks about everything ranging from sex and the way that sexual desire changes mood, and the way that that changes things like sleep, needs, nutrition, and the way all of that changes. And it really is a good starting point for deepening understanding and intimacy within relationships.

A (82:57)

If you could offer one remedy to heal a sick culture, it could be physically, emotionally, or spiritually, what would it be?

B (83:03)

Recognizing our humanity. You know, each one of us is a flawed human being, but we all share this really core human nature, right, that we can oftentimes recognize in other people. Like if we see somebody do something and we don't understand why they did it, instead of erring on the side of assuming that they're a terrible person because they did something that you don't agree with, just recognizing that most people are actually pretty good and having a little bit of grace and just recognizing that all of us are human. I actually teach a class in. In evolutionary psychology where I teach people about human nature. And part of that is recognizing that human beings are capable of some of the most beautiful acts of altruism that you could imagine, but then also can be capable of doing really terrible things and recognizing that within human nature there is all of these. All of these different types of motivational states and being able to recognize that and just recognize humanness.

A (83:56)

So beautiful. I have been wanting to have you on for years. This was so worth the wait. I love your books. You have have changed lives of women forever. I have so many, you know, stories from my audience of just. I even posted myself, like, prepping for this interview, reading your books and, and they were like, oh my gosh, this book changed my life. So I know that, yeah, they, they are hype about you and for good reason. And so we're just really grateful to have you and thank you for all of your tireless work and, and late nights, I'm sure, writing and getting these books out there.

B (84:26)

Thank you so much for having me. I've been so excited to come and talk to you. And I love, I love hearing from women. There have been so many women who. Who've had the experience of never having anybody validate the things that they were experiencing when they were on hormonal birth control and, and even as their hormones change with. As we go through the period brain. And I love being part of what's allowing women to feel seen and heard. So thank you. Thank you.

A (84:47)

Thanks, Sarah, for coming on Culture Apothecary.

B (84:49)

Thank you.

A (84:53)

I have been wanting to interview Dr. Hill for years, so this has been a very long time coming for me. Her book absolutely changed my life. I mean, that was one of the first books that I read, your Brain on birth control. When I first started kind of going down the rabbit holes on food and pharma and birth control, that was just one of the first things that really radicalized me. So big thanks to her. She's really taught me a ton. And I love that we were able to have this conversation and we do not agree politically, but we agree on this. Please leave a five star review and tell everyone why they've got to be listening to Culture Apothecary. This is the number one health and wellness podcast from a conservative perspective. We're on a mission to heal a sick culture physically, emotionally and spiritually. Twice a week on Mondays and Thursdays, 6pm Pacific, 9pm Eastern. My name is Alex Clark and this is Culture Apothecary.