Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / How Birth Control Changes Your Brain, Mood & Relationships with Dr. Sarah E. Hill
Transcript
- Dr. Sarah Hill: [00:00:00] Women who are on hormonal birth control seem to be attracted to different types of men. Ooh. Relative to women who are not on hormonal birth control. And it was then had this aha moment where I'm like, oh my gosh, birth control changes your hormones. Hormones influence behavior. Of course the birth control pill changed me. Right. Of course, the birth control pill can affect who you're attracted to. The pills in effect, everything. And so that was when I went to the research literature and I like dug into all of the research that had been published on the impact of hormonal birth control on our brains, and then also the way that women think and feel and experience the world with the hippocampus. Mm-hmm. And the stress response, I mean, this is like. This is kind of alarming as a medical doctor, like we were Dr. Taz: never taught to think this way. No, no. Welcome to Whole Plus, the podcast that embraces and tackles the holistic way, bringing it all together, science, research, innovations and technology, and our collective human experience. This is where science and spirit come together. I'm Dr. Taz, your host and a double board certified medical doctor [00:01:00] and integrative health expert, a nutritionist and an acupuncturist. I'm also the founder and CEO of whole plus a digital and clinical platform where my team and I practice evidence-based holistic medicine every single day. I know and I hear all the health and wellness noise that's out there. I want this show to be the one to empower you with the knowledge you need to heal. Not just your body, but your relationships, your communities, and our world. Welcome to Whole Plus. This is a question I get asked every single day in practice. Is it okay for me to be on my birth control and I find myself a little bit torn, right? If you need birth control, you need birth control, but I've always held out that we really shouldn't be using birth control for hormone regulation, and this next interview just blew my mind when it came to the topic of birth control. Please join me in welcoming Dr. Sarah Hill. She's the author of This Is Your Brain on Birth Control. She's an award-winning researcher who has spent most of her 20 plus year [00:02:00] career studying women relationships and health in addition to having established an award-winning health and relationships lab. I love that. At TCU, she has published nearly a hundred academic research articles and is a sought after public speaker. She sits on scientific advisory boards, basically a scientific badass advocating for women's health. Please join me in welcoming Dr. Hill to the show. Dr. Sarah, you are here with me today, and your invitation to be on the show was very purposeful. We have a mass confusion, so to speak when it comes to birth control and if it's good for us, if it's bad for us, I've got a teenage daughter, if. What do we do? So I know you're here to help us understand this a little bit better, and I've looked at some of the science and the research around the birth control pill and what it's doing to our brain. I know you've done a much deeper dive into all of that, but before we jump into that, you know, really juicy topic, talk to me a [00:03:00] little bit about what led you to be an advocate for women's health and women's health research. Dr. Sarah Hill: Well, you know, I actually started out as a scientist, um, as an evolutionary psychologist. And so what this means is, you know, we look at biological principles, um, from that, from evolutionary biology, and then we use that as a framework to understand human behavior. Dr. Taz: Mm. Dr. Sarah Hill: And when you're studying things from an evolutionary perspective and sort of understanding like why we've inherited the traits that we've inherited and like why, you know, women, for example, are, you know, somewhat different than men and all of this stuff. Like I had a deep. Appreciation of sex differentiation, right. Just this idea that male bodies and female bodies and male brains and female brains are a little bit different from one another and not in ways that, you know, where one is better than the other. It's just that we've been sort of optimized for different paths because of the different roles that we play in reproduction. And so, just to give an example of this, Dr. Taz: yeah. Dr. Sarah Hill: Um, for women, you know, you have a minimum nine month [00:04:00] investment for any act of sex. And for men, the minimum investment from any act of sex is like five minutes, like in reproduction, right. So for a woman, like if a woman has sex, this is purely from a reproductive standpoint. Yeah. Reproductive standpoint. Right. And you have to understand that investment Dr. Taz: in sex is sometimes a little bit more than that. Yeah. Well, no, no, totally. Dr. Sarah Hill: So. You know, from an evolutionary perspective, we can understand differences between the sexes based on the role that each men and women play in the act of reproduction. And, you know, evolution of course happens by some genes getting passed down and other genes not getting passed down. Right. And so we can actually understand a lot about human behavior by understanding what qualities would've helped to promote gene transmission if you have a male body or a female body. Interesting. Right? And so it's very, you know, as, and, and, and it's different, right? Right. So for example, um, in order to reproduce, women have a minimum nine month investment. Right. Because of course, pregnancy, right. For men to reproduce their minimum investment is like [00:05:00] five minutes. Mm-hmm. Right. Or however long it takes them to talk somebody into having sex and then actually having sex with them. Right. And this small difference in minimum investment and reproduction actually leads to the evolution of a lot of difference, sex differences. And so, just to give one example of that, women tend to be more sexually cautious mm-hmm. Than men and are less sexually opportunistic. Meaning that they're less likely to just consent to sex. Right. You know, for the sake of sex. Because our brain has been wired to be sexually cautious because over the course of evolutionary history, if you had women who were just willing to have sex with anybody, right. There was no birth control. Mm. Right. And then you'd end up in this situation where you have a child, and you know, throughout most of our history, we lived as hunter gatherers. And those women wouldn't have done very well. No. They wouldn't have been able to get access to food and so on and so forth. Right. And so my research career started out really focused on sex differentiation. Right. How are men and women somewhat different from one another based on the different adaptive challenges that [00:06:00] confront you? If you have a male body or a female body? Okay. And so, um, you know, this is my background. Okay. And a lot of my research has focused on things like hormones and, you know, and women and like sort of looking at women as women. And when I got into the world of neuroscience and I started to see the way that biological sex was handled in research, I was appalled. It's totally different, right? Well, it, well, it, it's appalling and I'm gonna, I'm gonna tell you why it's appalling. Yeah. I wanna know. Yeah. Dr. Taz: Well, I mean, I think this is what we see in the exam room, honestly, is I think that's what you're about to tell me because we see research applied to women that's really not meant for women. No, it's not. Dr. Sarah Hill: No. And, and the, and, and, and so, and that's like the bikini medicine model. Dr. Taz: Yeah. Dr. Sarah Hill: But bikini medicine is a product of bikini science. Dr. Taz: Mm. Dr. Sarah Hill: And science studies women as being, you know, like when you look at fields like neuroscience, for example, they study women, um, just as if they are men with a couple of hormones. Mm. And so when women are included in research, [00:07:00] they're only included in research during the first part of the menstrual cycle when hormone levels are really low. And so they only study women when they're maximally male. And so, you are kidding me. No. And so all of the health recommendations, this is, I've never heard this by the way, this is called Bikini Science. I call, so this is a thing that I, so I have a new book coming out called The Period Brain, and in that book I talk about bikini science. Okay. And, um, so nobody's really used that term before. But ultimately, bikini Medicine is this idea that men and women are indistinguishable from one another except for, you know, the parts of the body Ah, okay. That you can cover with the bikini. Got it. Okay. Bikini science is the same thing, right? It's this idea that we should, you know, we can study things in men and then just apply them to women. Which doesn't work 'cause our bodies don't work the same. It's like almost every system in our body, ranging from our brain to our cardiovascular system, to our immune system, has to rewire what it does when we get pregnant. And because of this, our body actually has found different [00:08:00] ways to do things than male bodies do. So just to give an example of this, when we look at the ways that male bodies and female bodies deal with bacteria. Mm-hmm. Right? So here's something that's immunological. Women's bodies have a a different way of doing it than male bodies do. And it's because female bodies have to also account for the fact that when they get pregnant that they need to not attack. Things that are genetically dissimilar to themselves. And so our immune systems are different than male immune systems because pregnancy requires our immune system to figure out different ways of coping with potential threats. Fascinating. Well, yeah, it's, yeah, it, it really is. Well, it's just, it's fascinating and it's so underappreciated. Well, I was just Dr. Taz: gonna say, as a medical doctor, like we were never taught to think this way. No, no. In terms of like, because of the central role of reproduction, we are entirely. Wired differently. And I think we've been on like a 20, 30, 50 year journey of trying to say we're not different. Right. And I think we've landed to, [00:09:00] in a time and place, and I'm so curious what you have to say about all of it where sex differentiation is getting really confusing. So, so this to me is just as a, as a medical doctor, someone who sees patients day in and day out, you know, is fascinating. But anyhow, I did not mean to interrupt. Please. Yeah. Well, no, no, Dr. Sarah Hill: but, but, but you're, you're hitting on the important issues here. And I think that, you know, for a very long time, because people were conflating sort of the acknowledgement of the importance of biological sex with then saying that gender is not important, which, which I would never say. Right. And I think that, that they're two separate things and that we can say, you know, biological sex matters, gender matters. Men and women are different from one another, but that doesn't mean that they're unequal. Right. You know? And, and I think that, that for a long time people were afraid to put too fine of a point on the idea that women's sex hormones matter. Yeah. Or that women might be different than men in ways that extend beyond our [00:10:00] reproductive organs because they're afraid of being seen as sexist. Mm-hmm. Or potentially providing, you know, the, some sort of, um, uh, uh, ammunition that could be used in sexist rhetoric Right. To harm us. Right. But, but the fact is that, you know, that there's nothing that, you know, in the ways that were different, that you could be, could really be used to argue that one way of doing things is superior than the other. Mm. And there's no reason that acknowledging the biological sex matters needs to, um, sort of make gender irrelevant. Right. Because it's not, I mean, it's different, right? Because even if you are, you know, if you are somebody who's a biological female. But you're male gendered, you still have a greater risk of autoimmune disease and Alzheimer's disease. Wow. 'cause you have a biological female body. Mm-hmm. You know, it's like you're wired that way, but that doesn't mean that your gender identity doesn't matter. It just means that you need to hold both things. Mm-hmm. Interesting. You know, both things to be held in your hand because you need to, when you talk to your doctor, they need to understand what your risk factors are for certain types of diseases. And those are, those are sex [00:11:00] differentiated. Wow. You know, for so many different types of outcomes. They are. And so as somebody who had a background in evolutionary biology, when I was getting into the world of like experimental neuroscience and these other things, and looking at the fact that. Yeah. Male subjects were being studied and then we were just applying those things to females as if they're going to be completely indistinguishable from one another. Right. Which I found just completely horrific. Insane. Yeah. And even like with something like Alzheimer's disease where women are overwhelmingly the ones who suffer from this condition, the overwhelming amount of research that's done pre-clinically on mice has been done on male mice. Mm. And it's like, you know, my guess is, and especially the more, 'cause now they've, they've been starting to put more pressure mm-hmm. On including both males and females in research. Although the way that that's being done is also totally messed up. And I've got a lot of. To say about that, but we don't need to cover that. Okay. Because yeah, we could end up like talking for three hours about like, like why are we doing things this way? Right. Um, but yeah. But [00:12:00] wait, can we just, can we answer that quickly? Yeah. Why are we doing Dr. Taz: things this way? Dr. Sarah Hill: I think that, you know, science started out before we actually really understood about the deep, you know, seated way that that male and female bodies differ. Right. I think that there was an assumption that men and women were virtually indistinguishable, minus, you know mm-hmm. Your reproductive organs. But, and, and so starting with that as a framework, I think that, you know, it was like, oh, well, you know, you know, women are just like men, but with some, you know, lady hormones. Yeah. And, um, and, and, and so science sort of moved ahead that way. And then once they realized that, that, well wait, maybe women are a little bit different. It's like, or, or we need to include re women in research. They wanted to do it in the way that was. Easiest to do, you know, using the existing paradigm. Mm. Right. And so the, the way that they've inclu started to include women in research is, um, rather than saying, okay, women have hormones that cycle [00:13:00] and women's bodies change and response to cycling hormones, and therefore when we're gonna include women in research, we should study them when, uh, estrogen is the dominant hormone. But then also when progesterone is the dominant hormone, because both of those hormones are gonna flip different sets of switches in the body. Dr. Taz: Yeah. Dr. Sarah Hill: And to fully understand women, we need to understand how they are under both types of conditions. Right. Rather than that, they said, okay, let's just study women when they're most like men. So that way we can include everybody in the same research and, um, and not have to test for sex differentiation. And that's the way that it's being done. And it's ludicrous and it has, um, made it where we know very little about women as women to this day, to this day. So that is, that is what has sort of led me on the path of being so, um, so much of an advocate for, um, for understanding women. Because currently the way that science deals with women is not treating them as women, is trying to study around the fact [00:14:00] that we're women and like our, our health. Like, we're never actually gonna understand the processes that impact our health, um, and how to best care for our bodies. Um, unless we change that and we have to start studying women. As women instead of just trying to statistically control for our hormones. Dr. Taz: Well, that immunological piece that you commented on mm-hmm. Because we're wired for reproduction and so we immunologically don't recognize things as foreign as quickly as men do. Right. Is that our predisposition to many different conditions, whether it's autoimmune disease or a mental health issue, or a bacterial load, or some of these things that we see in Dr. Sarah Hill: practice that is definitely one of them. Okay. Right. I think that's definitely a big, a big piece of it. Another, um, another really interesting thing that, uh, there's this really great hypothesis out there about, um, women's greater risk for autoimmune disease. Mm-hmm. And it has to do with the sex hormone, progesterone. Oh yeah. Mm-hmm. And so progesterone, um, of course is, uh, it's immune. Immunomodulatory because progesterone [00:15:00] increases, um, when you're getting ready for implantation. Right. And then also it's high during pregnancy. Um, and one of the things that progesterone does is it tamps down the immune system. Right. And it does this so that way you don't attack an embryo and you don't attack a baby as it's growing. Um, and you know, now of course, most women, because, you know, throughout most of our evolutionary history, we spent a lot of time pregnant. Mm-hmm. 'cause there was no ability to regulate our fertility. Right. Right. And, um, and so progesterone has served as a really important break on our immune system. Right. And so the female immune system is actually more potent than the male immune system in the absence of progesterone. Mm-hmm. Like women's immune systems tend to be more, um, they, they just tend to be more intense. They tend to be able to. Better capture and kill things, um, than male immune systems, particularly under the, um, when, when interesting women are in the estrogenic phase of their cycle. Yeah. Yeah. And, um, and so progesterone is served on a break to [00:16:00] this like, 'cause it tamps that down. And so one of the leading hypotheses, and this is being done in the world of evolutionary medicine, which is just a totally fascinating field, is looking at, you know, when you're not having, um, regular cycles, like if you're on birth control, you're not releasing progesterone. Right. And, and the progestins. In birth control, do not act the same as progesterone. Okay. We've got to dial into that in the immune system. Yes. Yeah. Yeah. And, um, that women, uh, essentially have this incredibly powerful supercharged immune system that's never having the breaks tapped on it in the way that it did throughout most of our history. Right. And so that our immune system is essentially like, you know, we're used to driving with our foot on the gas and the brake by having estrogen and progesterone and like, and then going through these periods of high progesterone during pregnancy. And when many women aren't experiencing that anymore, when that's removed, you know, it's like. All of a sudden it's just like you're driving with your foot totally on the gas and there's no break. And so that [00:17:00] auto, that that sort of, um, heightened activity of the immune system is believed to be a contributing factor to the fact that so many more women, um, develop autoimmunity now than they used to. And when you look at traditional societies where women are still, um, having babies all the time, yeah. You don't see, you don't see it, these differences in autoimmunity. It's very fascinating. Dr. Taz: Interesting. So you wrote, you wrote about this, you wrote a book called, this is Your Brain on Birth Control, correct? Yes. Yes. So the, talk to us a little bit about that book and the premise of that book and, and then I wanna get into birth control a little bit, and this difference between progestin mm-hmm. And progesterone. Yes. Because, you know, I've, I feel like I've spent a lot of time in the exam rooms talking about progesterone is an anti-inflammatory, calms the immune system down in the right dose, whereas progestin, we know in research can be inflammatory. Yes. So how and why did you hone in on birth control? Dr. Sarah Hill: I honed in on birth control because it was actually kind of my personal journey with birth control. And, you know, as as noted, I, I spent my early career, [00:18:00] I, I was really focused on women and understanding women, um, and our different psychological forces that, you know, sort of guide our behavior, including our hormones, right? So I, I had written some papers looking at how estrogen and how when estrogen is increasing near ovulation, how that's related to motivational changes and other types of behavioral changes in women. And so I'm publishing papers on the stuff. Meanwhile, I'm on birth control pills, right? And so here I am, I'm publishing papers about, you know, the impact of our sex hormones on the way that we think and feel and experience the world. And I'm taking birth control pills and never thinking about the fact that if our hormones influence our behavior, right then birth control probably also influences our behavior. But I wasn't thinking about any of that, right. But then I went off of birth control pills, so I was on them for more than a decade. Um, I went off them briefly. I've got two children. Um, so I went off them when I was pregnant. Um, 'cause I got pregnant very quickly with both of my kids, fortunately. Um, so I had my kids and then when I was breastfeeding, of course I wasn't on it either. Um, [00:19:00] but other than, you know, these little periods of time, which hormonally are weird, you know, it's like when you're lactating and pregnant, like that's not a, like a typical, you know, state for, um, for most people. Um, but I, you know, I was on birth control for like, I don't know, 12 or 13 years, almost nonstop, except for those little blips in time when I was having babies and lactating. And I went off of it and about three months after I went off of it, I was like, oh, like what is this? Like, I feel great. Like I, I was like going to the gym again. Uhhuh. I was downloading new music, um, for the very first time in. A really long time I was like more interested in sex again, in a way that I didn't even know that I would be anymore. I thought I kind of outgrown it. Right. You know? Right. I was like cooking. It was just anything that was like, sort of pleasure related. I felt like I had more energy, I just felt more alive, more dialed in. And I was like, oh my gosh. Like, was that because of the birth control? Like, did birth control do that to me? And, um, and I didn't really think that much of it [00:20:00] until a, a couple years later I came across some research that was showing that, um, women who are on hormonal birth control seem to, um, be attracted to different types of men relative to women who are not on hormonal birth control. And it was then, you know, I, I like had this aha moment where I'm like, oh my gosh, birth control changes your hormones. Hormones influence behavior. Of course, the birth control pill changed me. Right? Of course, the birth control pill can affect what you're attracted to. The pills can affect everything. And so that was when I went to the research literature and I like dug into all of the research that had been published on the impact of hormonal birth control on our brains, and then also the way that women think and feel and experience the world. And I was absolutely shocked that this information is out there in the world, but we don't talk about it. We don't talk about it. Yeah. And it's like here I was, you know, a woman who studies a brain. And who was on birth control and I didn't know it, you know? And I'm like, how, what hope does anybody have? Right? Does anybody else have if I don't know [00:21:00] this stuff? And so that was what led me on the journey to write the book. This is your brain on birth control, was to put this information out there. Not to say, you know, birth control's bad, don't go on birth control. 'cause I don't believe that. Right, right. But instead it's just about understanding the trade-offs that you're making when you go on it and knowing what to look out for. Right. Because there are some things that you can look out for. 'cause everybody responds to it a little bit differently. There's no sort of one size fits all response to any type of, uh, of hormonal birth control. Right. But there are things that we know from the, the research literature that can happen and just looking out for those things and then, you know, being able to adjust your birth control if you don't like the way that you're feeling or, you know, discontinue it and trying something else. Dr. Taz: Let's get into the science of it for just a second. So, some of the research that I was looking at talked about the fact that the progestin in birth control, I didn't, I didn't dig into the estrogen component. I'm sure you know more about that than me, but the progestin at least was shown to trigger high cortisol. Mm-hmm. In the hippocampal [00:22:00] area in particular, which is in the brain and helps regulate our stress response. That, to me, was one very clear example of how a hormone, a synthetic hormone is influencing how we think and how we feel. What. Other science is there connecting some of the hormones and synthetic birth control, even what's in the IUD for example, which is a common mm-hmm. We both have teenage daughters, which is a common form, you know, that, uh, many GYNs are resorting to now, you know, what do we know about what these hormones are doing to the brain? Let's start with the brain. Dr. Sarah Hill: Oh, gosh. Well, you know, the, the research that you're talking about with, um, the hippocampus mm-hmm. Like that, that research, and there's been a few other studies that have come out, I think, since the one that you're probably talking about. Right. I mean, there's also been some research looking at the hypothalamus. Yes. Um, but it, it, I mean, it. You have receptors for sex hormones all over the place in the brain. I mean, there, I can't think of a single area in the brain where there's not sex hormone receptors. And again, it's because our brains need to change what they're doing [00:23:00] depending on what hormone, you know, like what's going on. Where we are. Yeah. Like where we are in the cycle and whether we're pregnant or not. And so our brain is just wired for hormones. And you know, with, um, with hormonal birth control, you're taking, you know, a naturally cycling woman who, you know, for a naturally cycling woman, you normally get these bursts of estrogen during the first two weeks of the cycle. Right. Prior to ovulation, you get, you know, estrogen increasing. It peaks right around day 14 of the cycle right. Prior to ovulation. And then it falls. And then during the last. 14 days of the cycle, or 12 to 14 days, the sex hormone progesterone is released. Right. And it rises and falls. And so for naturally cycling women, um, our brain is used to sort of, you know, having to be really plastic and respond to, okay, increasing levels of estrogen, decreasing levels of estrogen. Mm-hmm. Increasing levels of progesterone. Decreasing levels of progesterone. And so our, our, our brain, like this is part of the brain's rhythm. If you're a female and with the birth control pill, you're taking the same daily [00:24:00] dose of hormones. And what this means is that our brain doesn't need that same amount of plasticity. Mm. Right. And so you, you get changes in the brain that are the result of the fact that you're not having to have this like waxing and waning of, uh, sex hormones and waxing and waning of sex, the number of sex hormone receptors, and so on and so forth. And so they found, for example, that the, um. Hypothalamus, which is the sort of endocrine regulator in the brain, is what regulates hormones is smaller in women who are on the pill. And it, that makes perfect sense. 'cause again, our brain is not having to adapt to, you know, increasing levels of hormones and decreasing levels of hormones and then having to signal to the ovaries that it's time to, uh, mature egg follicles and, um, and instead, you know, it's just getting the same daily hormonal message every day and it's never having to signal to the ovaries. And so that's going to, um, you know, that's going to lead to differences there with the hippocampus. Mm-hmm. And the stress response, I mean, this is like, this is kind of alarming. Yeah. Um, you know, and, [00:25:00] and what the research finds is that women who are using hormonal birth control, which again, has these progestins, which are not biologically identical to progesterone, that this is then leading to differences in the hippocampus. Because what seems to be happening is that these progess. Stents because they're not biologically identical, they tend to be non-binding specific, right? Meaning that they will bind to receptors for things other than progesterone, right? Two of the things that we know that they bind to besides progesterone are testosterone. In COR and the glucocorticoid receptors or cortisol receptors. And what seems to be happening in the case of the hippocampus is that these glucocorticoid receptors are getting overstimulated by these progestins and that that's causing damage in the hippocampus, and it's also causing the stress response to oftentimes partially shut down. And this is the sort of thing that we tend to see in people who have P ts D or who've suffered trauma where through the [00:26:00] result of, of being exposed to constant stress hormones, which happens, you know, right? If you have P ts D or you've been exposed to like childhood trauma, you're getting constant bursts of cortisol, which your body will not put up with because it's so disruptive. And what the body will do when you're getting constant glucocorticoid signaling is it just shuts it down. And it's like, all right, no more cortisol response for you. And um, what we tend to find is that women who are using hormonal birth control, that they have a blunted cortisol response to stress. Relative to naturally cycling women and, and healthy, you know, men. And it seems that the culprit behind this is that, um, that the body is essentially trying to cope with this by releasing a lot of, um. Glucocorticoid. Yeah. Binding globulins. Yeah. Right. So, um, these things that bind up cortisol and make it inactive, and although it might seem like, wow, that's like great, you know, like I get out of jail free card with stress. Like if like, oh, I don't release cortisol in response to stress, like maybe [00:27:00] that's a good thing. It's not a good thing. It's like it's a bad thing. Like even though cortisol is bad, if it's being released constantly, because it is very disruptive to the systems in the body, it's incredibly healthy and adaptive to be releasing levels, like high levels of cortisol in response to stress. Right. Having little bursts of cortisol release when we're experiencing stressful events is part of what helps us cope with stress. Right, right. And learn from stress and that plasticity that you're talking about. Yeah. And all that plasticity. Yeah. And so, um, you know, that's just one of the, you know, many ways that, um, the birth control pill can influence our, the functioning of our brain and then also, you know. What our brain creates, right? In terms of our moods and our behaviors, and even things like attraction. Dr. Taz: Wow. The attraction thing to me is so interesting, right? Like, on birth control, off birth control. Would you pick the same person? What does the science say? Dr. Sarah Hill: Yeah. That's so interesting. Well, so here, here's, um, here, in order to answer that question, I feel like I, I [00:28:00] need to first explain a little bit about, about why that research question was even asked. Dr. Taz: Okay. Fair. And the Dr. Sarah Hill: reason, and the reason that that research question was asked was because there's a lot of research, like 20 or 30 years worth, worth of research showing that when estrogen is rising in the cycle, so as estrogen increases, that this is associated with an increased, um, attunement to, um, sort of masculinity and testosterone markers in men. Hmm. And it's hypothesized that this. Uh, that this happens because testosterone is believed to be what we call a good genes marker. Um, because only men whose bodies are in like really good condition, um, during development, will allow their bodies to release high levels of testosterone during development because it's immunosuppressive. Mm. And so you have to have really good immune genes in order to release a lot of testosterone during development because your body will simply not allow it if your immune system isn't able to cope with, you know, the every, you know, day to day. Right, Dr. Taz: right. Dr. Sarah Hill: Um, uh, presence of pathogens and so. You know, so the idea [00:29:00] is that women at a time in the cycle when sex can lead to conception are going to be zeroing in on qualities related to good genes. Mm-hmm. Right. Including testosterone levels. Right. And so there's been recent some muscles and the hunky guy. Yeah, yeah. Deep boys, all stuff boys. Um, you know, social dominance. Right. You know, so like having sort of like a dominant type of personality, authority, power, you know, that sort of thing. And, um, and so there's been research now for like 20 or 30 years showing that. As estrogen rises in the cycle for naturally cycling women, not, not only do women have higher sexual desire, which they do, and they tend to have more sex and they initiate more sex and so on and so forth when estrogen is high and rising in the cycle. But also that they really zero in on these qualities related to, to testosterone cues. And um, so this of course then begs the question, what happens when you suppress estrogen levels on the birth control pill? Mm-hmm. Because women who are on the pill do not ovulate and they never go through this period of having estrogen [00:30:00] be the dominant sex hormone. Because the way that birth control works is it has relatively high levels of that synthetic progesterone or progestin mm-hmm. And really low levels of synthetic estrogen. And so women are never in that type of psychological state that would lead them to be really dialed in to cues related to testosterone in men. And so researchers ask the question. What happens then? Like, does that mean that when women are on the birth control pill, that they might be less dialed in to men's testosterone levels and might they sort of, instead of prioritizing cues related to facial, vocal and behavioral masculinity, might they instead focus on other types of cues? Might they instead prioritize, you know, things like whether somebody's going to be a good father or a good partner. Interesting. Because, you know, all mating is a trade off. Right. You know, it's like you're always balancing like the, you know, 'cause we, of course everybody wants it all, but you have to make the balance between like, you know, Mr. Sexy sex and then like Mr. Good [00:31:00] investor. And most women sort of, you know, fall somewhere in the middle when they're choosing a partner. Mm-hmm. Um, and you know, and, and so the idea here is that you know, when you don't have estrogen in the mix, sort of leading you toward those masculinity cues, that it might sort of minimize that the role that, that looking for those kinds of cues plays in partner choice. And what research finds is that lo and behold. Women, uh, who choose their partners when they're on hormonal birth control do seem to be, um, choose, uh, partners. Like there was one study, for example, that showed that women who chose their partners on the pill chose partners with less masculinized male faces. And this wasn't like these huge differences, right? Where you look at like, oh my gosh, how could these, you know, women choose these partners. It's not at all, these are slight differences, but estrogen really, and there's been a lot of follow up research just looking at what does estrogen do in the brain mm-hmm. That might make women sort of gravitate toward these testosterone cues. And it seems that, um, [00:32:00] estrogen just increases our sensitivity to them. So really small differences in facial masculinity. Women, when estrogen is high, are able to detect them. Women when estrogen are low are not Dr. Taz: Oh, wow. Which Dr. Sarah Hill: is really interesting. Huh. And so there's been some research showing that women tend to, um, choose partners with less masculinized male faces. There's also been some research that finds that, um, women who chose their partners on the pill tend to report less sexual attraction. Yeah. Less sexual satisfaction. Um, you know, just sort of everything related to sex is rated a little bit low. Libido is Dr. Taz: one I hear a lot of. Yeah. Low lower Dr. Sarah Hill: libido. Yeah. And, um, women who chose their partners, uh, when they're, uh, na naturally cycling tend to score higher on all measures of attraction and sexual desire. And, and also just, um, you know, sex drive and, and libido as you noted. Um, but the women who are on the pill, um, tended to report greater satisfaction with things like their partner's earning capacity and, uh, [00:33:00] in their intelligence and some other qualities. Interesting. Suggesting that, that, you know, that being on the pill and keeping estrogen low might just sort of shift where our trade offs are. Like what are the trade offs that we're making in terms of our partner choice? Huh. And this of course, begs the question then. What happens if you choose your partner when you're on the pill and then you go off of it? And there's been some research looking at that too. Dr. Taz: What happens Dr. Sarah Hill: and, well, it's, it's really provocative and it's really interesting. And Dr. Taz: is that the divorce rate? Dr. Sarah Hill: Yeah. It's like got off my pill and I'm like, uh, not you so. So if women choose their partners when they're on the pill and then they go off of it, what seems to happen is it's almost like an awakening that happens. So one of the best studies that's been done asking this question was done on a longitudinal study of married couples. Mm-hmm. And it followed people over time and looked at changes in things like sexual attraction and sexual satisfaction and relationship satisfaction. Um, and they followed women and their partners over time. And as it just so happened to turn out, [00:34:00] about half of the women had chosen their partners when they were on the pill. And about half of them had chosen them when they were off the pill. And they were really interested in zeroing in on these women who chose their partners when they were on the pill. And they followed them as some of them started to discontinue the pill. Right. And so here you're following women who chose their partners when they're on the pill, and then they follow them over time. And about half of those women eventually discontinued birth control use. And what they found was that after women discontinued birth control use, if they had chosen their partner when they were on the pill, that it led to sort of a, a, a. Bimodal response on the part of women. For some women, it made them more attracted to their partner. So they go off of it and all of a sudden they're like, oh my gosh. And they're really attracted to their partner and their relationship satisfaction goes up, their sexual satisfaction goes up. They feel more attracted to their partners. For the other half of women, what they found is that their relationship, satisfaction, attraction to partner and sexual [00:35:00] attraction to partner all went down. Oh wow. What was the deciding factor? How attractive their partner was. And what they found is that women who were partnered to attractive partners, when they went off of the pill, it was like the blinders came off. Mm. All of a sudden, estrogen was priming their brain to be really sensitive to those small differences in testosterone levels. So what they found was that the driving factor that made women differ in terms of whether or not they were more or less attractive to their partner was how attractive they were and for women who chose their partners when they were on the pill and then went off of it, who felt more attracted to their partner? Yeah. It seems like the blinders came off and estrogen, you know, all of a sudden they were having estrogen, making their neurons really sensitive to these small differences and testosterone levels among men. And they're like, oh my gosh, my partner is so sexy, and they're like really attracted to them and they're having more sex and their relationship satisfaction goes up as a response for women with lesser apart, attractive partners again. Blinders come off and all of a sudden you're more sensitive to these fine tuned differences. [00:36:00] And this then might lead you to feel less attracted to your partner. Right. And so whether it like going off the pill, if you chose your partner when you're on or off of it just depends on what partner you chose. Oh my gosh. And I mean, I've heard from women, you know, of course this. My, my birth control book, um, came out like five years ago now. Okay. And so I've gotten so many emails from women and I mean, I've heard stories about like all of a sudden they could smell their partner and that they didn't like the way that they smelled. Huh. Or they could smell their partner and they loved the way that they smelled. But it's like birth control. It does something. It masks our ability to be able to, I think, assess genetically compatible partners because women are like really attuned to things like scent and other types of cues that men are not attuned to. And those things matter. And estrogen, it sort of fuels our brain's receptivity to information from the environment and makes us more sensitive to things like smells and things like taste and other things like that that can play an important role in made choice. And so, [00:37:00] you know, should women who chose their partners on the pill be scared? No. You know, no, you shouldn't be. You shouldn't like freak out. And, and there's a good chance that if you go off the pill that, that you're gonna either be more attracted to your partner or not have noticeable differences, but sometimes it can lead to differences. Wow. And so it's a risk, like do I think that it's like a super high risk where people need to be losing sleep over it? No. But can it happen? Absolutely. Dr. Taz: Oh my Dr. Sarah Hill: gosh. I wonder Dr. Taz: what the divorce rate was. The groove that came off the pill and had attractive partners versus the one that came off the pill and had quote unquote unattractive partners. Right. Dr. Sarah Hill: Well, so what's really interesting about this is, um, so in that study, they did not look at this, but there was a different study Okay. That looked at a large sample of Yeah, of course there was. That looked at a large sample of, uh, people who had chosen their partners either on or off the pill. And the way that they did the study is they just asked people to talk about the, um, person that they had their first child with. Right. Because they wanted to [00:38:00] look at people who were also divorced. Right. And so they're like, all right, think about the partner that you had your first child with. Um, did you choose them when you were on, on birth control or off the birth control pill? Are you currently married? Dr. Taz: Mm. Right. Dr. Sarah Hill: Did you get divorced? And if you got divorced, who initiated the divorce? Mm-hmm. So what they found, and this is really fascinating 'cause it's counterintuitive, what they found was that the divorce rate was actually higher in women who chose their partners off the pill. Huh. So, naturally cycling women, and when we think about the types of qualities that estrogen is attracted to, it's not always the types of qualities that are good for long-term pair bonding. Gotcha. 'cause there's a whole deep body of research showing that men with higher levels of testosterone don't always. Well, they make the best partners, right? They tend to have more, they're moving on. Yes. They tend to have more short term sexual partners. They're more likely to have affairs. And there's this whole list of things. And so like on the, so that, um, on the, you know, on the one hand it's like sort of counterintuitive. 'cause you might think, well, you know Yeah. If you choose your partner [00:39:00] on the pill and then, but here's the other piece of it. So yes, women who chose their partners when they're naturally cycling do have a higher divorce rate than, than the women in, in this study anyway. Who chose their partners when they were on the pill. But when the women who were on the pill, or pardon me, when the women who chose their partners on the pill did get divorced, they were overwhelmingly the ones to initiate it. Yeah. Interesting. Which is super interesting. Yeah. Um, and we know from research, and this is also sort of surprising, it surprised me anyway, but divorce is generally, um, something that's initiated by women instead of men, which surprised me when I first learned that. 'cause I thought it would be 50 50 or I didn't know. Dr. Taz: Right. Dr. Sarah Hill: Um, but even Kim, even when you control for like what the normal rate is, the sort of female bias and who initiates divorces, the rate was higher for these women who chose their partners on the pill, suggesting that there is something to this idea that women, when they choose their partners on the pill [00:40:00] and then they discontinue the pill, that this can cause problems for some women and for some it can lead to things like relationship dissolution and even divorce. Interesting. Wow. So it just changes who we are. It does. Yeah. I mean, our hormones, uh, change who we are and I think that we're starting to see. Recognition of that with our conversations with like menopause, the menopause transition. It's like people are actually starting to take it seriously because women are saying like, I'm a different person. I'm a different person. Like biologically I feel different, and psychologically I feel different. I feel different. I'm different. And it's like, oh, really? Hormones matter. Like really? Yeah. Well, here's the Dr. Taz: connector that I would love for your perspective on. So birth control progestin. Mm-hmm. Conjugated estrogen or synthetic estrogen. Mm-hmm. Right? Mm-hmm. HRT. Mm-hmm. Primarily. Well now people are using more bioidentical progesterone. Mm-hmm. And they're using estradiol. Mm-hmm. You know, these different hormones that we're giving women, no matter how old they are, they're all influencing the brain, right? Yes. And is there a [00:41:00] hormone that influences the brain in a more negative way than another? Like bioidentical progesterone versus progestin, right? Estradiol and a patch that many women are wearing today versus. Conjugated estrogen and a birth control pill. I've got, we've got the whole teen piece that we need to talk about, but even, you know, a lot of my patients going into their thirties and forties are on continuous birth control because they were prescribed that as a way to manage their hormones, or even as an anti-aging longevity strategy as they're going into their forties. So help us with what's going on there. Dr. Sarah Hill: Wow. Yeah. Yeah. There's so much there. Yeah. So, to start with, there's a big difference between biologically identical hormones like progesterone mm-hmm. And estradiol. And, and these, um, synthetics, especially like the, the estrogen, it's a little bit of a more. I don't know that it's that big of a deal. They're pretty similar. Mm-hmm. Like, I would say that the, like when you look at things like binding specificity, like it's binding [00:42:00] to the right places and it's also got good binding fidelity, meaning it stays on the receptor it's supposed to stay on. And so, um, with the estrogen, I feel a little bit less concerned about the distinction between the synthetics and, you know, the, the sort of like truly biologically identical estradiol. Um, and so we can sort of shift that to the side side. Okay. And talk about the differences between progesterone and progestins because the, if you look at the literature, especially on hormone therapy, it is an absolute mess. Mm-hmm. Because everybody is combining these two things together and talking about them synonymously. Right. When they're not the same in, in so many different ways. And I'm just going to give you a few of them. So the first thing, like, let's just talk about what a progestin is. Um, most of the time when you have a synthetic hormone, it's actually derived from the hormone. Right? So even like the weird estrogen is, is made from estrogen. Like sometimes it was like the pregnant MA's urine and all of that. Right. Of course. Course estrogen. Yeah. All that stuff. Yeah. And, [00:43:00] um, with progestins, they're synthesized, most of them out of testosterone. So they take a testosterone molecule, they monkey with it molecularly, and so that way it will bind to progesterone receptors, but it doesn't have good binding specificity and it doesn't have good binding fidelity, meaning it falls off the receptor a lot of the time with the progesterone receptors. And it will also bind to other things, including as we noted, um, cortisol receptors and testosterone receptors. So it, it does all of those weird things. Right. So it's kind of like a Franken hormone? Franken hormone. Dr. Taz: Oh my gosh. I like that. We have to use, that's like built. Yeah. Dr. Sarah Hill: It's like, it's like taken from something and then built into something else and it's like a Franken hormone and it does weird things in the body and we don't understand them all. So that's like one difference. Other difference is that progesterone, when it gets broken down in the body, it releases this really beautiful neurosteroid called Allopregnanolone. Dr. Taz: Mm-hmm. Dr. Sarah Hill: And Allopregnanolone is a [00:44:00] biological, like wonder drug in a lot of ways. It increases neuroplasticity. Yep. It's anti-inflammatory. It, I mean, it does like all of these amazing things in the brain. It, it stimulates GABA receptors, which is calming to the brain. Hmm. And so it, it has a lot of really positive benefits. Um, and you don't get allopregnanolone release from the breakdown of progestins. And so women who use progestin instead of progesterone are missing out on one of the key benefits of progesterone in the first place. Wow. Which is that it's neuroprotective. It's anti-inflammatory. It's anti-anxiety. Not to mention the fact that progesterone, true progesterone is anti-proliferative in the body, right? So rather than causing cells to proliferate, it causes cells to differentiate. Mm. And so it reduces the cancer risk in a lot of cases. Progestin because it's made out of testosterone. Right? Which is proliferative [00:45:00] increases cancer risk. And this is, you know, there was this recent, um, study that was published in, I don't remember, I think it was it Lancet, but it was talking about. Um, the dangers of hormone therapy, and it was talking about progestins and as if they were progesterone and they're not. And when they compared the group of women who was taking estrogen and progestin, their cancer rate was higher than a control group. Mm. When they looked at women who were using estrogen only, their cancer rate was decreasing. And so, like people are being told that hormone therapy is dangerous. Right. And, you know, estrogen is dangerous. It's progestin. It's progestin. Yeah. Progestin is not good. There's nothing good about it. I have nothing good to say about progestin except that it, you know, in birth control, it prevents people from getting pregnant when they, you know, and, which I think is a huge, you know, we need to have access to these products to, you know, prevent unwanted pregnancies, but it, it does nothing positive for the body. Progesterone does and, and can and, and there's a lot of confusion in the [00:46:00] literature and the way that they talk about it. You'll have articles. In scientific peer reviewed journals, credible ones that are talking about progestins and they call it progesterone throughout the Right. All the Dr. Taz: time. All the time. It's so confusing. Yeah. Well it is Dr. Sarah Hill: so confusing. Yeah. And it's, um, and it's, it's bad for women because then you end up with headlines saying that hormone therapy is dangerous. Right. And it's not, it's not, you know, it's, it's like so helpful for so many women and it can be really health beneficial instead of being health deterring. Do you like testosterone and Dr. Taz: testosterone replacement? Where do you land on that one? Dr. Sarah Hill: Well, I, I do, I think the pellets are not great. I hate pellets. I know, I know. I'm gonna go on record. I hate that. Thank you. Yeah, no, no. I know. That's what, um, my, every, everybody I know who has used pellets, right. And practitioners like you who have had experience with pellets are anti pellet. Um, and you know, when you read about how they work in the body, I mean, it's like if it doesn't agree with you, you're screwed. Right. You know, it's just a terrible idea. Like, I don't think it's a terrible idea, but that being said, adding in [00:47:00] testosterone to a lot of women is hugely beneficial. And so in pellet form, no. Like, you know, right. Maybe a gel something else. Like I don't, um. I know, I do know that adding testosterone therapy when your testosterone is in the toilet can be really helpful. I like DHEA. Mm-hmm. Which of course is a, use a lot of that precursor, um, to testosterone. Mm-hmm. Because then a lot of times your body will sort of kick things up enough where you're feeling more mm-hmm. Motivated and having higher sexual desire. Um, 'cause a lot of women go on it for those types of reasons. Dr. Taz: So we've got this whole issue with progestins. I'm. You know, my head spinning. I'm like, is that where breast cancer rates up? Is that why this is up? Is that why that's up? I mean, you don't have to necessarily answer those. That's probably another deep dive. Right, right. Yeah. And that would be deep dive because Of course. Yeah. Like I'm not a, I'm Dr. Sarah Hill: not a, you know, medical doctor. Right. But I will say that just knowing what I do about what these things do on the cellular level, that would be my hypothesis. I, I would predict we would predict that. Yes. That's what I would predict. Dr. Taz: Would you also, now we both have [00:48:00] teenagers, would you connect that back to the increasing A DHD, anxiety, depression, mental health component we're seeing in our teenagers? Dr. Sarah Hill: Yes. Yes and yes. So there has been a lot of research that finds that. Um, when you look at the mental health related side effects with hormonal birth control, the ones who asymmetrically bear, the burden of that risk is teenagers. Mm. And so when you look at, for example, the rates of developing anxiety, depression, or being diagnosed in antidepressant, um, and you compare, uh, girls who are taking, uh, birth control, the way, the way that it's usually studied is, uh, women ages like 15 to 19. Right. We consider that like adolescents, adolescent women who are taking birth control. Um, their risk of both, um, depression and even, um, suicidal ideation and suicide is, is in some cases double, in some cases more than double. Wow. What It's adult women Wow. Who are given the exact same product. And so we need to be [00:49:00] very. Very careful with our teenagers when it comes to these sorts of products. And even with things like, you know, a lot of times there's this, um, belief that the hormonal IUD is somehow better because it's low doses of hormone. Right? Right. Yeah. That one's one of the biggest offenders, because that's progestin as well. It is progestin and there's no estrogen. Right. And so, and for many of these girls and women, when you're on it, especially the first year, you're not ovulating. And this is because the progestin levels are enough to shut off ovulation in the brain. Mm-hmm. Because ovulation starts in the brain, which means these progestins are reaching the brain. The brain is not communicating to the ovaries that it needs to ovulate. And because of that, women aren't producing their own hormone levels. Like they're, they're not producing their own hormones. And so here you have really low progestin, no estrogen, and women aren't making any hormones of their own. They feel weird. Mm-hmm. You know, they feel terrible. Is that like the out of body and the Dr. Taz: eating and like all these other things Yes. That are coming up with our girls and our young women? Dr. Sarah Hill: Yeah, no, for sure. I think that we have vastly [00:50:00] dismissed the psychological risks of birth control with teens. And I understand it's like a very, you know, um, especially when we're talking about teens who are sexually active, the birth control discussion is very tricky because obviously an unplanned pregnancy right. Is like one of the biggest risk factors of, of ending up in poverty, right. As a young adult woman. And so this is like, I mean, this is a very real risk and um, but for women who are using birth control for just like heavy for hormone regulation. Yeah. Hormone regulation, you know, heavy periods, acne, other things like that. It's like, I don't know that most women would. Want to make that trade off. And if they did, they at least need to be informed about it. Yeah, like, like if I had a teen that was considering going on birth control and we felt like that was the best option, I'd be watching her like a hawk. Dr. Taz: Yeah. Dr. Sarah Hill: Just to see whether her mental health was changing. But parents aren't being told this. No, Dr. Taz: they're not. And the Dr. Sarah Hill: other thing they're not being told is that, especially during the adolescent years, so you know the time of puberty up until your [00:51:00] brain is done developing, your brain is developing, like your brain is undergoing. The biggest transformation that our brain ever undergoes in our lifetime is between puberty and adulthood. And our brain is under a big remodeling project where it's transforming itself from its child version of itself into its grownup version of itself. And that developmental change is initiated and coordinated by sex hormones. So what happens to brain development when you shut down sex hormones? It's, nobody knows. I mean, it's like nobody knows. Mm. Nobody's doing this research. Mm-hmm. And, um, and it's critically important. And, and, and the few studies that have actually looked at what does adolescent birth control pill use do mm-hmm. To brain development, have found that it does seem to increase the risk of developing major depressive disorder throughout your lifetime, even after you go off of it. Wow. And so it's like. This is really important information for girls and their parents to have. And it's important information for physicians to have. Definitely. 'cause doctors [00:52:00] aren't told this. No, this information is published in neuroscience journals. And I mean, it's like, I'm sure that, um, you are very well aware there's a silo problem in science and medicine. Yeah. Where everybody lives in their own little universe. Yep. Single, single solutions. Single solutions. And, and it's, and this information isn't being communicated to people. And it needs to be, because again, it's like, would you still make the decision to go on the pill as a teenager, um, for fertility regulation and avoid pregnancy? Maybe. Would you do it just to avoid cramps if you know that it might put you on the road for a lifetime? Increased risk of major depression, major depression. Probably not. Yeah. But we're not told that information and, and hardly anybody's doing the research. Nobody's even thought to ask the question. And this, again, it's like any type of research that's like targeted at women as women tends to get ignored. Oh, this is one of them. Well, Dr. Taz: you're seeing this stuff in the laboratory and I'm seeing it in the exam room. And I would, you know, you know, I can, I can almost hear people's questions saying like, okay, well what, [00:53:00] what do we do? I have a, I have a teenager, or I'm a young woman and I need, you know, birth control mm-hmm. For birth control. Mm-hmm. Right? Mm-hmm. What's the answer? What do we do? And what I'm hearing from you is if you need it from birth, for birth control, it should be limited. It should be for a short duration of time. And it should maybe be supported, you know, I don't know if there are other hacks or other things you've seen in the research. Mm-hmm. I have a, a few opinions about that. But we should not be collectively using birth control. For hormone balancing and hormone regulation. Meaning if you have a heavy period, if you have a painful period, the answer in the exam room should not be, here's your pill. Dr. Sarah Hill: Exactly. 100%. And yeah. And when it comes to women who are, and, and young women who are seeking for controlling birth, right? I mean the, here I've got three things to say about that. Love it. Okay. We need to push for more options. Mm-hmm. I mean, you know, but part of the, my motivation in writing this book wasn't to like, again, to bash the pill because I'm not anti [00:54:00] pill. Right. Um, it's that we need to not be complacent about this. Right. Like, we have almost no options. I mean, I feel like women, like we have our backs up against a wall when it comes to regulating our fertility and we need to demand more. Mm. Um, and so I say, you know, we need to push for, we need to push for more solutions, especially for our teenagers. You know, the second thing is that, um, if. You know, if, if, if you need fertility regulation for fertility regulator or birth control for birth control, um, the, the copper IUD, um, is, is non-hormonal. And, um, and, and some women really love it. Some women hate it. Hate it, right? Because it does increase cramping. I mean, it is an imperfect solution, but it is at least a, you know, long acting reversible contraceptive that doesn't have hormones and then doesn't influence the brain. Probably not okay, because it, um, you're still ovulating when you're on it and it does cause an inflammatory response near the cervix. And, but generally it's not enough where it reaches the brain in ways that are going to cause either developmental issues or even mood issues. Some [00:55:00] women can get mood issues from the copper IUD just because that level of, I've seen Dr. Taz: a lot of weight gain with the copper IUD. Oh, Dr. Sarah Hill: that's really interesting. Yeah. Yeah, no, that's really interesting. Um, and yeah, so, but it'll, it'll at least keep your hormones intact. The other thing is, the third thing I wanna say about that is. If you feel like you need to be on birth control for birth control, um, it's okay. Yeah. You know, it's like, does it influence brain development? Probably. Does it influence brain development in a meaningful way? We don't know. Hmm. You know, there's a chance that that, you know, yes, it can, may increase your risk of, um, developing major depressive disorder, but that might not be true for everyone. Right. It might be just certain populations. I mean, we just don't know. And, um, and if you feel like you need to be on it, like don't, you're, you're probably going to be okay. And I think that's an important message. And, and if I had to choose one, I would choose the, the combination hormonal birth control pill, not the IUD. Not the vaginal ring I would choose because when you look at the, which has some [00:56:00] estrogen in it. Yes. That's why it has some estrogen in it. And when you look at the risk profile, um, because they've done these big, beautiful studies in Scandinavia where they look at the entire population of people that live there. So it allows you really fine tune differences, like to be able to look at what the risk of developing depression, for example, is depending on the product that you're on. And what they, what the research finds, especially in teens, is that there is an increased risk when you use the combination hormonal birth control. Pill products. Mm-hmm. Um, but that it's not nearly as high as it is for non-oral products. Interesting. So I would say use a combination pill. Dr. Taz: So combination, first combination pill I copper IUD, maybe second. Dr. Sarah Hill: Right. Or I would, I would flip that. I would say copper IUD first. First is my, and then the combination birth control pill second. Gotcha. Um, and in those were the, you know, those are the recommendations I would make for my own daughter, um, in the, you know, case of trying to avoid pregnancy because using things like the fertility awareness method and all of that, like, it's really great if you're an adult. I don't think I trust a teenager. Well, I know. Well, [00:57:00] exactly. You know, and yeah. I mean it's, it's like if you're somebody for whom in an unexpected pregnancy wouldn't be all that big of a deal. Right. You know. Speed. Right. I think it's great. Right. Um, if you are not, like I don't, and especially for a teenager. Yeah. Like you were saying. I mean, we have teenagers and we know what they're actually like Right. When we were teenagers. Exactly. We know. We're like, right. And it's like, it just doesn't, you know, it's not a great idea. Doesn't translate. Not a great idea. Dr. Taz: One of the things too, as you know, an encouraging message, I think if you do find yourself or your teenager in that position where you have to go on birth control, one of the things we've done in our clinics is really set up a plan to support mm-hmm. Taking that birth control, which actually gets into some of the macronutrient and micronutrient mm-hmm. And balances that birth control pills can create. Mm-hmm. Like a deficiency in B vitamins. Mm-hmm. A deficiency and vitamin A and vitamin C. Getting in more of those Omega-3 fats. Mm-hmm. All of those kind of nourish the brain mm-hmm. In a little bit of a different way while we're having this sort of hormone, you know, uh. Ping pong kind of going on. Right. And we feel like that that's something that, you know, I [00:58:00] feel very passionate about educating both parents and teenagers about like, yes, there's gonna be a phase of life where you may need this, but these are the things you can do to support the brain. At the same time, I taking down your risk for I love it. Some of those things, you know, I love it. Dr. Sarah Hill: And it's also, it's really interesting 'cause one of the things that we're working on right now is, um, looking at, uh, supplementing. With micronized progesterone. Mm. For women who are on hormonal birth control. Interesting. 'cause then you can still get all of those really beautiful neuroprotective effects. Yeah. And mood stabilizing effects of proje that you get from progesterone. And it's really lovely. Um, metabolite allopregnanolone. And so we are actually, um, working on starting a research study looking at this in the context of alcohol craving because one thing that we found is that women who use hormonal birth control seem to be at a greater risk for developing alcohol use disorder potentially because they're, they have more alcohol craving, which makes sense when you consider the fact that allopregnanolone stimulates [00:59:00] GABA receptors in the brain, which is the same thing that gets stimulated with alcohol. And so they may be self-medicating for lack of GABAergic activity in their brain. Mm. Right. So they're trying to calm their brain down by drinking alcohol. Since they're not getting that internal calming from the allopregnanolone. And so we, we are working on trying to create a study where we're gonna be looking at hormonal birth control users and then supplementing them with a micronized progesterone or a placebo, and then looking at alcohol cravings in use. But my guess is that it will be. Hugely beneficial. Oh, sure. I mean, I just For sure progesterone is so safe. Yeah. And, and the side effect profile is so minimal. Yeah. And it does so many beautiful things in the brain that, um, I think that I'm like really excited and I'm excited about that as a possibility. I mean, even just for future research with, you know, people like, you know, girls in the clinic, I wanna Dr. Taz: like, I wanna partner. Yeah. I love that. You know, we didn't have time to get into DHT and, and androgens and the rise of androgens that we're seeing as well. I don't know if you've studied much of. Much of that whole area. Dr. Sarah Hill: Right? Yeah. So I haven't, but [01:00:00] yeah, no, I, I, I always am told by men who are using testosterone, right? Especially men who are using testosterone, you need to write the book about the, about what happens to your brain on testosterone, because I feel like a totally different person. Oh yeah. And yeah, definitely. There's very interesting, that's a Dr. Taz: whole nother, yeah, a whole nother ball of wax. Well, this has been like fascinating 'cause I'm seeing it in the exam room, but to see it kind of validated from a research standpoint I think is so interesting. And then obviously, both as a mom and as a doctor that sees patients of all ages within our clinics, you know, we really want to be able to provide families with, with sort of the overall holistic framework of how they need to be thinking about. Hormones and birth control and, and like what we need to be doing. We're not saying don't do this, but have a supportive plan around it. And I think hearing the research from you is, is fascinating. So thank you so much for your time today. I could probably go for another hour. Where can we learn more about your work and what you're doing? Dr. Sarah Hill: Yeah, you can find me online@sarahehill.com and that's Sarah with an [01:01:00] H. Dr. Taz: Okay. Dr. Sarah Hill: And, uh, I have a new book, the Period Brain that's coming out at the end of September. And so you can find that, um, anywhere books are sold. Um, and so you can look for that. And I'm on social media and my handle is at Sarah E. Hill PhD and that's across all Dr. Taz: platforms. Amazing. But before you leave me, I ask this question to every guest. Dr. Sarah Hill: Okay. Let's hear it. Dr. Taz: Are you ready? Let's hear it. What makes you whole? Dr. Sarah Hill: What makes me whole? Um, I think what makes me whole is my connections with other people. Oh. And not, and like, I feel very, you know, like grounded as my own person. So not in a you complete me sort of way. Mm-hmm. But in, um, being grounded within a network of people that I love, I think is what makes me whole. Dr. Taz: Amazing. Well, thank you again for your time today and for everybody else watching or listening to this episode of Whole Plus, make sure you share it with anyone that has a teenager or a young woman who is trying to make some of these decisions. Or even if you're in your thirties or forties and you're using birth control for hormone regulation, there's probably a better [01:02:00] way. We'll see you next time. Thank you so much for listening to this episode of Whole Plus, be sure to share this episode with your friends and family. And if you haven't already, please take a moment to subscribe to this podcast on YouTube or wherever you get your podcast. To engage with the community, follow at Live Whole Plus and check out our website holplus.co. That's HOLplus.co. For more resources and information on holistic health, see you next time.