Athena (00:00:04):
Have you been zombified by birth control? Welcome to the Zombified Podcast, your source for fresh brains. I'm your host, Athena Aktipis, psychology professor at ASU and chair of the Zombie Apocalypse Medicine Alliance.

Dave (00:00:22):
And I'm your cohost, Dave Lundberg-Kenrick, community outreach program manager at the psych department and brain enthusiast.

Athena (00:00:29):
Yes, brains. We love brains. That's kind of what brought us together to do this podcast. Really?

Dave (00:00:37):
Exactly.

Athena (00:00:37):
Yeah. Yeah. So in this episode is about, uh, pills and brains, particularly birth control pills and how they affect our brains and our bodies in ways that we have not, until now, recognized and seen because nobody has really pulled all of the work together to see what's going on since our guest, Sarah Hill wrote her book.

Dave (00:01:04):
And so, uh, so what is your favorite thing about this episode that we're going to listen to today?

Athena (00:01:10):
What I love about this episode is that Sarah really uncovers this whole, like this, the physiology of how birth control pills affect our stress systems and how, like the way that we even respond to things in our environments is different if we're on birth control pills.

Dave (00:01:37):
Interesting. [Athena agrees] So, and what's the most surprising thing you think about?

Athena (00:01:42):
Um, it was also that,

Dave (00:01:44):
It was also that?[Dave laughs].

Athena (00:01:44):
Yeah, yeah, it blew my mind talking to her and like the way that she could explain all these different aspects of the physiology in a super clear way. So, um, it really, it, it changed my brain.

Dave (00:01:56):
Interesting. So now does she say that we should all go off birth control?

Athena (00:02:00):
No, in fact, she's really, she tries to be really clear that what she is suggesting is that people just need to be more informed about the effects so that they can then choose a method of birth control that works for them. And, um, that, you know, it's not, it's not like now with this information, everyone who's on birth control should go off it. It's just, you should know that it's potentially gonna have those effects and choose, uh, a method of birth control that, that will work for you. Because not all birth control methods are the same. And what she's really focusing on is hormonal contraception. So yeah, the pill [Dave agrees] and that, the effects of that on, uh, our, our brains.

Dave (00:02:44):
Cool. Um, so real quick, Sarah Hill.

Athena (00:02:49):
Yeah, so, Sarah Hill is a psychologist who works on really biology and behavior. She's at Texas Christian University and she is really one of the pioneers for looking at physiology and women's health from an evolutionary perspective.

Dave (00:03:11):
Great.

Athena (00:03:12):
Yes. So let's hear from her.

Dave (00:03:15):
Sounds good.

Intro (00:03:16):
[Psychological by Temi]

Athena (00:03:54):
Welcome to Zombified, Sarah.

Sarah (00:03:54):
Thank you for having me.

Athena (00:03:55):
Would you introduce yourself in your own words for all of us?

Sarah (00:04:00):
Sure. I am, uh, Sarah Hill, and I am a psychologist. I'm a professor, um, at uh, TCU in Fort Worth, Texas. And um, I'm also the author of a new book called "This is Your Brain on Birth Control."

Athena (00:04:16):
Oh, awesome. Well, I can't wait to hear more about that. About your book and how birth control zombifies us. I assume that that's part of what goes on with birth control.

Sarah (00:04:29):
Right, is, yeah, it makes you a complete zombie and a slave to your, a slave to artificial sex hormones and making you act out their demands [everyone laughs].

Athena (00:04:40):
So how did you like get into this whole field and where did your interest in like hormones and birth control in particular come from?

Sarah (00:04:49):
Well, it actually started when, uh, I went off the birth control pill, so I was on the pill for more than a decade. And um, when I went off of it, I felt like I woke up, like I felt like life was sort of one dimensional and flat. And about three months after I went off the pill, I just realized that recently life had been more interesting and that I was like listening to music again and I was like, wanting to go shopping [Athena laughs] Which sounds so like, it's like, I'm like setting women's lib back like 65 years. [everyone laughs] Yes, but it was like, I wanted it to look attractive. Like these were things that I totally had sort of forgotten about. You know, I was like, wearing my mom jeans and like doing that sort of thing.

Athena (00:05:35):
Mom jeans are back though.

Sarah (00:05:37):
Oh and, I know! I don't understand. Like we have these beautiful girls that go to the school I work at and um, and I see them in these mom jeans and I'm like, why? Why are you doing that? [Sarah laughs]

Athena (00:05:47):
I don't know. For me, I'm like super happy because like-

Sarah (00:05:50):
Oh, no.

Athena (00:05:51):
I like the high waisted.

Sarah (00:05:53):
I think you're being zombified by your mom jeans. [everyone laughs] Turn you into a different person, [Athena laughs] turn you into somebody else. Um, but, uh, so I wouldn't, when I went off the pill, it was like, I, um, I was noticing men again, I was interested in exercising again. I just had more energy. I felt vibrant is really what it kinda came down to and everything felt more three dimensional. And, um, and so this really, you know, sort of intrigued me and, um, but I didn't do anything about it at that point. I was just like, wow, I think the pill might've like really kind of made me kind of a different version of myself than who I am when I'm not on the pill. Um, and then I was at a research talk, um, at a research conference, um, SPSP which is the Society for Personality and Social Psychology. Um, and there's an evolutionary pre-conference there. And, um, our friend and collaborator, Bruce Ellis, was, um, talking about some of his research on, um, early life stress and um, and how it influences the stress response. And this sounds like he doesn't have anything to do with the birth control pill, but it does.

Athena (00:07:00):
Yeah, I'm not sure yet.

Sarah (00:07:01):
Yeah, ok. We're going to get there. We're going to get there.

Athena (00:07:03):
I am on the edge of my seat, though. [everyone laughs]

Sarah (00:07:05):
So, he was talking about the data collection and he just mentioned offhand that, uh, they only use men, um, to actually test their research hypotheses because um, 90% of the women and their sample were on the birth control pill. And what they noticed was that women in the birth control pill don't have a stroke. They don't have a cortisol response to stress.

Athena (00:07:26):
What?

Sarah (00:07:27):
I know, which is like what you see in people with PTSD and [laughter] who experience chronic childhood trauma. And I um, so he just started talking about the other stuff and the results and I was just like, wait a minute. Like what, can you talk about what goes, you know, on with the birth control pill [Athena agrees] and the stress response? Cause that was the most interesting part. The rest of the talk was fine. I love Bruce, love his research, but that was all I could think about. And, um, so I went back to my office, um, and I started doing some research into, you know, the pill, and the brain, and the stress response. [Athena agrees] Um, and that's like a thing like women who are on the birth control pill don't experience, um, a cortisol, um, stress hormone response to experiencing stressful experiences, which again is something that you only see, generally, in the context of somebody who's been chronically stressed or like in, you know, in a terrible, you know, warfare type of a context where their stress response went into such overdrive that it just got broken. And this is something that happens in, in pill-taking women.

Athena (00:08:31):
Ok so, if a woman is on the pill and the zombie apocalypse happens-

Sarah (00:08:35):
Right.

Athena (00:08:35):
Is she not going to be as good, at like, let's get the fuck out of here right now?

Sarah (00:08:40):
[Sarah laughs] Probably not. Like, you know, so I, you know, here's the thing is that, um, you know, the, the having that stress response, um, plays a really important role in terms of our ability to cope with stressors. Um, and it also plays a really important role in terms of like shuttling information from a stressful experience and like getting it into our long term memory. So that way, like when there's another zombie apocalypse, [Athena laughs] you know, you can recognize the signs, right? You're like, oh, that man is eating that man's brains. [everyone laughs] Last time that ho- happened, it was the zombie apocalypse, therefore, you should probably leave and go somewhere else. And, um, and so, you know, not having this response doesn't like, eliminate stress, and women feel just as stressed out, um, when they're on the pill as when they're off of the pill. But not having this response makes them less able to cope with stress, um, and less able to sort of absorb the meaning from the stressors in their environment to use later on. Um, and so this, all of this, and I started reading about, you know, the way that the pill, um, changes the brain. And, um, you know, and it was funny because um, you know, I'm a psychologist, so are you, and, um, and I studied women and I studied health and I was on the pill for more than a decade, like I should have known about this. [everyone laughs] You know, I felt like really embarrassed [Athena laughs] that it never occurred to me that the birth control pill might be changing what women's brains do, but of course it does because our sex hormones play a really important role in terms of when, you know, sort of neurochemical signaling, you know, that influences what our brain does and the version of ourselves that our brain creates. And so when you're on the pill, your brain is creating a totally different experience of the world than when you're off of the pill.

Athena (00:10:24):
Wow.

Sarah (00:10:24):
And so, yeah, it sort of, it does zombify what your brain does and, um, influence the, you know, sort of version of yourself that you're going to be. And so I wrote this book because once I sort of had that stupid, ah, embarrassing aha moment for a psychologist, I'm like, Oh yeah, sex hormones, they influence the brain. So yeah, let me change that, [laughter] it's like probably going to change what the brain does. Um, I, I wanted to make this information available to all women because we don't know.

Athena (00:10:51):
Yeah.

Sarah (00:10:51):
Women have no, um, information about what happens with the birth control pill, like from the neck up. Everything when their doctor tells them is what goes on from the neck down, heart attack, you know, thrombosis, you know, weight gain. But they don't talk about how it changes the brain. And so this is, um, uh, my attempt to make this information about how the pills zombifies, um, women and, uh, changes what they do available to everybody and not taken out of the context of these horribly, you know, horrible to read journal articles that you and I have to contend with when we're doing our jobs, [Athena agrees] and uh, and then making it available to everybody in sort of a fun and easy to read kind of a format.

Athena (00:11:35):
Yeah. So you were kind of joking about like, you know, setting feminism back. But like I want to like ask you like about this more because it is kind of a tricky space to be in, right? Where you're like, Hey, the pill is having all these effects on us that we didn't know about and we should know and we should be making an informed decision, which is really like a feminist perspective, but then it can be potentially viewed by maybe a previous generation where the pill is such a symbol of women's freedom over their sexuality.

Sarah (00:12:09):
Right.

Athena (00:12:09):
So how do you kind of navigate that?

Sarah (00:12:11):
Right, yeah. I mean it really is a, it is a tricky space and I think um, I think in the book I did a pretty good job of being very, you know, this, this book is just about, you know, it's not pro-pill, it's not anti-pill it's like pro-women, pro-information. And it actually, um, I think it's actually really empowering to women to learn about, to start with, how their sex hormones influence the way that their brain works. Um, learning about the different types of pills and then what the research shows about how they influence what women's brains do. Um, and then allowing women to make really informed decisions about their health. I mean, when women don't have this information, which they haven't been given, cause they're, you know, we aren't taught, like, I don't know about you. I have no idea about the way that your cycle changes your hormones or the way that your hormone, you know, hormones across the cycle change what your brain does or the way that brains even work. I didn't know any of that stuff until I was in graduate school. You know, and, and most people aren't, you know, intellectual masochists, [laughter] you know, and do that sort of thing. And so women aren't taught about how they work and, um, and then they're not taught about what the pill does. And so I want to give this information to women. Um, so that way, you know, they're able to, um, like, not be at the mercy of their doctor of, telling them like, well, you, you know, just take this, because I think that really puts women in a submissive position where they're like, totally at the mercy of their doctor's knowledge about the way that their brains and bodies work and actually putting the power back in the hands of women to be able to understand the way that it all works, how it changes on the pill, um, and then be able to make informed decisions about their own health. Because this is really all about empowering women and allowing them to have more choices, not fewer choices. And so it is sort of, I think it is a very pro-feminist position, but you're right, there is sort of a, this really, it is sensitive topic because you don't, um, by sort of raising, um, the issues that can occur when you're on the pill. Um, it does, you know, like call into question, you know, the thing that it has single-handedly done more for women and our advancement than any other thing in history. I mean, I can't think of anything, I don't know if you can, um, that has been more transformative for women than being able to remove the consequences of sex, um, from sex. Because, I mean, you do, one thing I cover, um, in, uh, my book that, um, I think is really, I, I didn't even really thought about it until I was writing the book and actually like, I'm getting goosebumps now, even just like talking about it, because it was like so powerful. Um, you know, I was, I read this article, it was by a sociologist and she was plotting, um, applicants, um, or applications to law and medical, um, and business schools, um, over time and, um, she was interested in the birth control pill, um, and how that sort of revolutionized, you know, women's, um, career goals and, and advancement. Um, and what was really cool, there was this really compelling figure where it showed that the percentage of applicants that were female, um, before the pill was available to single women, and then after. So the birth control pill began being available in the 60s, but it wasn't actually allowed for single women to get prescriptions until the 70s.

Athena (00:15:28):
Really?

Sarah (00:15:28):
Isn't that nuts? Yes, totally cra- yeah women had to basically show that they were married to get the pill before that -

Athena (00:15:35):
Wow.

Sarah (00:15:36):
Yeah, I know it was just like such stupid, sexist bullshit. [Sarah laughs]

Athena (00:15:38):
Yeah, totally.

Sarah (00:15:40):
Totally awful. Um, but right at 19-, I think it was like 1970 was the first year that the pill was made available to single women. And what you see is--and again, we're doing the goosebumps--1970, um, 10% of applicants to, um, to, uh, law, business, and medical schools were women. Um, within 10 years of the pill being available to women, it jumped up to almost 40%.

Athena (00:16:07):
Wow.

Sarah (00:16:08):
And like really what it is, is more than anything else when you think about it, um, is that the pill and like, and just having control over fertility is something that allows women to plan. You know? [Athena agrees] Because if you're really thinking, like, if you're thinking about like going into a school, a degree where you're not going to get done until you're 30, I mean, the idea that you're not going to be having sex, it's like ridiculous. [Athena agrees] You know, it's like, it's like ridiculous in the context of like college, I mean really. High school for some people, depending on who you are. [Athena laughs] But I mean it really, um, the idea like it's, it's just, it's really, you think like our great-grandmothers couldn't dream that big because they would know that there was a very real possibility that all of their hard work midway through med school or whatever it is, would get totally laid to dust because of a pregnancy that they weren't anticipating.

Athena (00:17:04):
Yeah, so this is the other side of your brain on birth control, [Sarah agrees] which is you can plan for the super long term because you have that control.

Sarah (00:17:13):
Right, you have control and it's really, um, you know, so it's like a really, you know, fertility regulation for women. I think is our biggest, you know, that is a thing, you know, and when you think about like sort of like Trevor's theory and like the abatement principle and you know all those--

Athena (00:17:25):
You have to like say a little bit.

Sarah (00:17:27):
Okay.

Athena (00:17:27):
At least context what you mean by that.

Sarah (00:17:30):
Okay, well, so when you think about these evolutionary theory is that, um, talk about like why men and women are different, ultimately what it comes down to is women, you have to bear this huge cost when it comes to sexual behavior. There's this potentially really big check she's going to have to write in terms of a nine month pregnancy that men don't. And ultimately that difference has been, you know, the sort of source of a lot of the evolution of our sex differences and the continued sex differentiation and our behavior. When you take something, we actually remove that price from women. It's a game changer. [Athena agrees] You're able to, and we've seen that the world has changed where women have become more like men. And I don't mean this negatively, this is going to sound like a, like a Rush Limbaugh, like women are becoming like men, you know. It's amazing, like I'm more like a man than I would've been without, you know, it's like we're able to be ambitious and we're able to have goals and we're able to have sex for pleasure and because it's fun and not just because, you know, we're planning a family and, um, and the pill has allowed us to do all of those things. And so it's, um, you know, like having that also, it makes us able to enjoy the things that men have been enjoying forever. Um, and so this issue of fertility regulation is just, um, it's so important, but like, it's also important to understand like, you know, if we choose the birth control pill as our method of doing this, like how is that gonna change us, and also just like letting women know, um, that science isn't really paying attention to what's important to us. And so I spend a whole chapter talking about the way that women have been mismanaged by, um, by medical research and, um, and putting out as a call to arms that we need to ask for more research on the things that are important to us, both in terms of the birth control pill and how it changes our brain, but also looking for alternative means of regulating our fertility.

Athena (00:19:24):
Yeah. Can you say a little bit more about this issue of like what has been missing in medical research?

Sarah (00:19:29):
Absolutely. This is such an important issue and it's something that, um, most women have absolutely no idea is going on. And it's the dirty little secret in medical research and that is that, um, most research has been done on males and often sometimes even males only. So as recently as like 1986 and which might sound like a long time ago, but it's really not that long ago in sort of the history of the world. Um, they were publishing papers called like "Normal Human Aging" that was done only on men. You know, it's like everything that we, most of the things that we know about humanhood and about health and disease, um, over the course, you know of, uh, medical research has been done on males and not on females. Um, and recently, um, about 15 years ago or so, the NIH has made a push where, um, any clinical work, so like research on humans, um, has to be done using both males and females.

Athena (00:20:28):
And just context. The NIH, the National Institute of Health, and they like fund a huge amount of medical research.

Sarah (00:20:35):
Yeah. Any research related to things like birth control pill or like how health and that sort of thing will oftentimes be funded by this organization. Um, and they have recently, um, you know, made some where they're trying to be more, um, sort of inclusive with research and you actually have to include statements in your proposals to get funding from this organization about how you're going to be including women. Um, and that's made things a little bit better, but oftentimes the inclusion of women in research is, um, very perfunctory and it's like they include some women, right? But they don't include enough women to be able to test for sex differences between males and females and how they respond.

Athena (00:21:14):
Hmm.

Sarah (00:21:14):
But even worse than that, um, so that's, you know, things have gotten a little bit better, but where things really, um, there still needs to be a lot more changes is what goes on in uh, preclinical work. So this is the research that's done on animals and cell lines, um, and most of the research that gets done on animals and cell lines about things that are really important to human beings. And especially women. So, um, I'll use Alzheimer's disease as my working example. Um, Alzheimer's disease is a disease that of course influences, um, or affects, uh, considerably more women than it influences men.

Athena (00:21:50):
Oh yeah? What's the sex difference on that?

Sarah (00:21:52):
Um, oh gosh, it's 60/40.

Athena (00:21:54):
Really? I didn't know that.

Sarah (00:21:54):
Yeah, yeah, it's pretty, it's pretty substantial. Um, and, uh, about 90% of the preclinical work that's done on the neural mechanisms that influence Alzheimer's disease--and when I say preclinical work, what that means is the research that's done on animals, because all medical research, um, especially in like in fields like neuroscience, start out, um, in animals. And so this is like, this is the front lines of research. Um, things don't get tested in humans until they've been tested in animals. And we sort of go up the chain as research goes. About 90% of research on the mechanisms that impact Alzheimer's disease that's done preclinically--so like what brain systems are involved, what neurotransmitters are involved, you know, what hormones are involved--are done on male mice only, male mice only. So females are only included like second, right? If something seems like it's working in males and they'll test it also in females or not at all. And so there's probably major breakthroughs in women's health, um, that we've totally missed because something would have worked in females, but they only tested in males. And, um, I want to provide a little bit of context for you all about why this happens because, um, you know, when you first hear this, you might think that science is full of a bunch of sexists who just hate women and want us all to die and you know, whatever. Um, but this happens, it's actually a by product of the competitiveness of science. Um, you know, I don't think that science is for the most part, obviously there's still--and I'm sure you've had this--the older male colleagues who kind of pat you on the head-

Athena (00:23:31):
Well 'cause it's cute you're trying to do science.

Sarah (00:23:33):
Yeah I know it's like "you're a girl!" Yeah, "look at that, like wow." [Athena laughs] You know, so there's still some of that, but I mean, I do think that things have gotten better. I don't know if you feel the same way. I mean, in terms of-

Athena (00:23:44):
Yeah, it's getting better.

Sarah (00:23:44):
'Cause there's more of us than them. I mean, you know, women are like, we're just kicking men's asses up and down. [Athena laughs] You know, when it comes to getting into medical school and getting into law school and getting into the sciences, our college graduation rates are better. Um, but, uh, when it comes to doing research, um, you know, science is super competitive. Um, for those of you who don't, um, aren't in the sciences, it's, um, it's really, um, it's really insane how hard it is to get a job. Um, and, you have to publish a lot of papers and every paper that you do is based on experiments that you've been running and spending thousands of hours in the research lab hoping that something is going to work out so we can write it up and get it published.

Athena (00:24:24):
Right. Not to mention spending the money from grants [Sarah agrees] in order to do the work and it costs a lot of money.

Sarah (00:24:31):
Which costs a lot of m-. Yeah. So it takes a lot of time, it takes a lot of money to do research and it has to be done quickly in order to survive and actually be able to get a job. Um, and testing on females--and this is true for human females and it's also true, um, for animals--um, requires, if you're going to be doing things, especially thoughtful medical research, you have to control for cycle phase. And for women there's at least three different phases of the cycle. You have to like, so then you would need women who are in the follicular phase, which is the first part of the cycle where estrogen is the dominant sex hormone. You need women in the second half of their cycle, which is the luteal phase where a progesterone is that dominant hormone. And then you'd need women during the menstrual phase where both sets of sex hormones are low. Um, so at a minimum you'd need, you know, women in the two phases. Um, and if you're doing really thoughtful research, it would be all three phases. Um, and you know, you can imagine that this is very difficult to do, right? It's difficult enough to do in humans, and we can tell people when we got our period last, and we can kind of guess, you know, sort of where we're at and you can schedule things accordingly. Like when we want to do studies, um, where we control for cycle phase, what we do is we have women call us when they get their period and we have them come into the lab five days later. And, um, but even that is hard, right? 'Cause like we can only schedule women when they call us, when we're looking for a male participant, you can just show up.

Athena (00:25:54):
Right.

Sarah (00:25:54):
'Cause we don't have to account for a cycle phase. And with animals it's even more challenging because they can't ask the mice when they were ovulating. And so they have to take vaginal smears.

Athena (00:26:04):
Right. And they don't menstruate, right? [Sarah agrees] So you can't look at that.

Sarah (00:26:08):
No you can't. You just have to take vaginal smears, um, look at, and then figure out where they're at based on these vaginal smears. And so doing research that includes, um, females or women, um, it is more expensive, it takes longer, and you need three times as many participants. Right, and the scheduling...

Athena (00:26:26):
Wow.

Sarah (00:26:26):
Is really challenging to do. Um, and this isn't my excusing science, what this is is me telling you like, everybody how this, why this happens, and that we need to change the way that our journal editors are allowing papers to get in, and change what the funding agencies are doing where they don't allow this research that doesn't include women and doesn't account for cycle phase to be getting published. Because once that changes, once the gatekeepers to science demand that this is what you have to do, it's gonna slow down the pace of science, it's gonna make it more inclusive.

Athena (00:26:58):
Yeah. Well I think that's also just a great point in general, like very often I feel like in academia, in the sciences, people have this attitude of, well, like, because the institutions work like this and this and this, we have to keep doing things the way they are instead of realizing on some level,

Both (00:27:18):
We are the institutions.

Sarah (00:27:20):
Yes, exactly. It's like we have power to, to change what's going on.

Athena (00:27:24):
Yeah.

Sarah (00:27:24):
You know, it's like these journal editors, like, we know a lot of them.

Athena (00:27:26):
They're our colleagues, right? Yeah.

Sarah (00:27:26):
We know who these people are. And um, I think that it's something that, you know, it's procedural inertia, right? Like where people are just sort of doing things the way that they've always been done.

Athena (00:27:38):
It's zombified.

Sarah (00:27:39):
Yeah, it is. It's like totally zombified. And so I think that, um, you know, it's like, you get into a routine, you know, [Athena agrees] and it's like these journal editors and the, and we're all in a routine, but it's like now that we understand the pervasiveness of sex differences and you know, you know, it's, it's time that we account for, and now that we know the pervasive effects of sex hormones and behavior, we also need to account for that. And we need to have, we need to change the way that science is being done so that we actually really understand all humans and not just, you know, males.

Athena (00:28:10):
Right.

Sarah (00:28:10):
And also like, once we get into this like new era, a new way of doing science, I think that, um, what we're going to find is that women's issues are studied a lot more frequently because it will be more attractive for people to want to answer these types of questions. Like, how does the pill do this? Or how do the sex hormones do that? Because everybody's science is going to be slowed down because everybody's going to have to be accounting for cycle phase.

Athena (00:28:34):
Interesting.

Sarah (00:28:35):
Yeah.

Athena (00:28:36):
Yeah. Well, and I mean it's also interesting to just think about this whole like burden of zombification on all these different levels, right? So there's like the institutions that have zombified the researchers so that they're only doing the research that is relevant to, or it's most relevant to male health. And then so women don't have the information about how their behavior is being affected by their own hormones, or the birth control pills. And so then you have the persistence of like the zombification 'cause the research isn't there that helps us understand the zombification because all the researchers are zombified by the institutions that we're in.

Sarah (00:29:18):
No, I think that you like, you have an amazing point. [Athena laughs] It's like totally true. And so, uh, so I can like, I look at my book as being like a zombie slayer. Like I'm going to be slaying some of these zombies.

Athena (00:29:29):
You should have a picture of yourself on the back, like as the zombie slayer.

Sarah (00:29:33):
I want you to take that picture when we're done with this interview. [laughter] We're going to pose for some pictures. And it's going to be amazing. You're going to have it on your website with the link to the podcast.

Athena (00:29:48):
There we go.

Sarah (00:29:48):
I'll be zombie-killer Sarah. Um, but, I think, yeah, women need, I think that, uh, the more information we have about how we work, you know, whether we're on the on the pill or off the pill, um, and like, knowing the forces that are zombifying us, right? It gives us control over the zombification.

Athena (00:30:03):
Definitely.

Sarah (00:30:03):
We get to choose, which zombie we want to succumb to.

Athena (00:30:08):
Right, like do we want to be zombified by a pregnancy or by the pill? Oh, like you choose.

Sarah (00:30:14):
[They laugh] Yeah, exactly, exactly.

Athena (00:30:16):
Yeah. We actually, um, in this season have, um, episodes with David Haig about pregnancies zombifying, and with Amy Boddy about microchimerism. So there are many zombification options having to do with reproductive choices.

Sarah (00:30:32):
Right? No, this is great. I think that like, you know, the listeners of your podcast can really like listen to each one of these episodes and like really, you know, um, like choose, it's almost like, it's almost like a, like a menu.

Athena (00:30:45):
That's right.

Sarah (00:30:45):
Like, who I want to zombify me.

Athena (00:30:48):
Yeah.

Sarah (00:30:49):
I'll take the pets, and microchimerism. [everyone laughs] Please assign her a Pellegrino. [laughter]

Athena (00:30:59):
So, so what were some of the like biggest surprises for you about how the pill affects women's behavior? Like as you were really digging into all of this.

Sarah (00:31:10):
Like for me the stress response thing was really surprising because I just really couldn't understand why, um, the birth control pill, but, because you kind of figure that it's gonna be influencing things related to sex, right, sex hormones, sex, [Athena agrees] you know, seems sort of intuitive, um, and that it was also influencing the behavior of stress hormones, kind of, really threw me off.

Athena (00:31:33):
Yeah, why is that, do you have any sense of that?

Sarah (00:31:37):
No, so, well, here's, here's my sort of ideas and let me just say that um, reading this research on the pill and the stress hormones, I felt like Encyclopedia Brown, you know, like I was having to solve this case because there was all of these weird results, but nobody had like put all the pieces together.

Athena (00:31:55):
I see.

Sarah (00:31:56):
And so I, I felt like encyclopedia Brown, so I was like, you know, sort of trying to solve the case of the missing cortisol. [Athena laughs] Um, and uh, what it looks like is happening, and so one thing that I learned in all of the reading is that, um, pill-taking women, you know, they have this lack of a surge of cortisol in response to stress.

Athena (00:32:19):
Like what kind of stress? Like give an example of like-

Sarah (00:32:22):
Well, like if you're giving a public speech for example.

Athena (00:32:25):
Okay.

Sarah (00:32:25):
Um like, that's something that really, it usually increases a women's levels of cortisol, which is a stress hormone, by about five- to tenfold. I mean it's like a-

Athena (00:32:33):
Really?

Sarah (00:32:34):
Like a huge surge in your stress hormones and um, with pill-taking women, you just don't get that. There's like,

Athena (00:32:43):
Like, at all?

Sarah (00:32:43):
No, in some cases they found, in some studies, when they stress women out that way they find that women have a decrease in cortisol.

Athena (00:32:50):
What?

Sarah (00:32:51):
I know it just doesn't even make any sense. I mean it's just broken, you know, their stress response at least in terms of their HPA axis, which is the part of the brain, um, hormone axis that is responsible for the release of cortisol, it just doesn't work. The, um, the part of the stress that you feel, like your sympathetic nervous system response, like epinephrine, this is the thing where your heart races and your mouth gets dry.

Athena (00:33:14):
Like your butterflies in your stomach.

Sarah (00:33:16):
Yeah. That, that part of their stress response is totally intact. And so that's why pill-taking women feel just as stressed out-

Athena (00:33:23):
Oh!

Sarah (00:33:23):
As the non pill takers, but they're not having this change in cortisol.

Athena (00:33:30):
And, so what does the cortisol do compared to the, you said it was epinephrine?

Sarah (00:33:36):
Epinephrine yeah, so epinephrine is more of a, um, it's like fight or flight, you know, it's the thing that gets your airways opened up and you know, um, gets you ready to run away, sort of, you know, mobilizes your muscles and you know,

Athena (00:33:49):
So they would be okay for that aspect of the zombie apocalypse.

Sarah (00:33:52):
Yes, exactly.

Athena (00:33:53):
They could run.

Sarah (00:33:54):
They could run, right. But the, um, but uh, cortisol, it dumps blood sugar into the, um, into the bloodstream, which allows, um, you know, which allows of course you to be able to mobilize those resources for getting away.

Athena (00:34:06):
Oh!

Sarah (00:34:06):
So they might go run but their, their tank might empty pretty quickly.

Athena (00:34:10):
That's interesting.

Sarah (00:34:10):
Yeah. And then also, um, it does a lot of stuff in the brain. So cortisol does a lot of things where it primes new cells, new brain cells to be born. So that way you can use that information, um, you can encode, um, what's going on. And it also helps to shuffle what's going on in like the short term, your short term memory, and um, sort of direct it into your long-term memory because it's telling you, it's basically earmarking in your brain, this is relevant. This is a biologically relevant moment. Remember it. And it happens not only when we're, you know, in the middle of a wildebeest stampede, but it also happens when we're falling in love. When you're first falling in love with somebody, like you have this huge cortisol response, like this huge stress response.

Athena (00:34:53):
Really?

Sarah (00:34:53):
Yeah. And it's telling, it's flagging, it's telling your brain, this is biologically salient, this is important. Remember this shit. You know, like this is stuff that's-

Athena (00:35:01):
Like lay down some pathways here.

Sarah (00:35:03):
Yeah, exactly. Like this is like this. Yeah, encode, encode, encode. And so um in, which is why one, the one part of the brain that has more receptors for cortisol than any other, um, is the hippocampus, which is like our learning and memory center of our brain.

Athena (00:35:20):
Really?

Sarah (00:35:20):
Yeah. And so-

Athena (00:35:21):
It's also like spatial stuff, right?

Sarah (00:35:23):
Yeah, yeah. It's spatial stuff and it's um, and it's learning and memory.

Athena (00:35:27):
Hmm.

Sarah (00:35:27):
And, um, what is, uh, one study that was really provocative, it just came out last year, um, looking at, um, cortisol in pill-taking women compared to naturally-cycling women, um, and brain scans of the hippocampus. Um, and what these researchers were interested in looking at was whether, um, women who, uh, are on the birth control pill might experience hippocampal shrinkage. Um, because what happens when your body is overwhelmed by cortisol--which is generally the state of affairs that leads to that total shutdown of the stress response [Athena agrees] that we're seeing in pill-taking women--they were interested in whether pill taking women, you know, even though they don't, they have a flatlined, um, sort of stress response in response to actual acute stressors like giving a speech or falling in love, um, whether they have higher total levels of cortisol. So we have like levels of cortisol, um, like when we talk about like a cortisol response to stress or something, we're talking about what's called free cortisol, which is unbound cortisol that your body's actually able to use.

Athena (00:36:32):
Is that like in the bloodstream?

Sarah (00:36:33):
It's in the bloodstream or saliva. It's everywhere. And, um, total cortisol um, includes the amount of free cortisol that's in your body, but it also has, um, the amount that's being bound up by, it's a binding globulin. So your body basically turns down the volume up and down in the stress response in part by releasing these binding globulins that basically turn down whatever it is that's being released. [Sarah coughs]

Athena (00:36:59):
Is that, like, a super quick way of binding up the um, um, like keeping it from being as high or-

Sarah (00:37:05):
Yes, yes. Yeah. So, so the body, the liver releases these binding globulins where if one part--well it also goes to show you that the whole body, right, is like not a, like a unitary thing. Right? [Athena agrees] And you actually have competing demands that are sort of working their way through the body, I think and, um, you know, and, uh and, so, like the stress hormones might get released. Um, but then like part of the brain is like, wait a minute, no, nope too much, too much.

Athena (00:37:31):
Mm hmm.

Sarah (00:37:31):
And then that orders the release of these finding globulins. Um, and so binding globulins actually turn up and down the, you know, if a lot is released, it turns down the volume of whatever it's binding and if not a lot of that's released, it keeps the volume high.

Athena (00:37:47):
Okay.

Sarah (00:37:47):
And so to go back to that stress response with women, um, they find that, um, these women, um, had, um, higher total levels of cortisol.

Athena (00:37:57):
Okay.

Sarah (00:37:57):
So they don't have a, they don't have a cortisol response to stress, but their levels of total cortisol are higher, which suggests that they may have experienced, um, the pill might be causing the body to become overwhelmed by stress hormones, which causes-

Athena (00:38:12):
Do they have the globulin? More globulin? Is that what's going on?

Sarah (00:38:14):
Yes. Yeah. So their total cort is really high, their free cort is really low. Um, and that suggests that, um, that their body's being overwhelmed by the stress response and has adapted. And the way that their body has adapted-

Athena (00:38:28):
Oh!

Sarah (00:38:28):
It's just by dumping binding globulins. Um, and so what they also found though, 'cause what they were really interested in was, um, whether, you know, um, in addition to, do these women have higher levels of overall cortisol, um, do they show other signs of trauma?

Athena (00:38:45):
Okay.

Sarah (00:38:45):
Like, 'cause you know, when you experience trauma, um, and experience that your body being overwhelmed by cortisol, it wreaks havoc in the body. [Athena agrees] It just absolutely wreaks havoc in the body. And just a dovetail for a second and uh, Robert Sapolsky writes about this beautifully and why zebras don't get ulcers. Um, what kills salmon when they swim upstream, um,

Athena (00:39:07):
Uh huh.

Sarah (00:39:07):
Isn't the swimming upstream. It's a cortisol response that they're experiencing that allows them to fight their way up the stream.

Athena (00:39:14):
Wow.

Sarah (00:39:14):
If you block their adrenal glands, um, from producing cort, they don't die. What makes their body fall apart is that cortisol shifts all of the energy away from maintenance into coping with a stressor. So it makes your body fall apart, literally fall apart.

Athena (00:39:31):
So this is like one of the potential risks in the zombie apocalypse, actually.

Sarah (00:39:34):
It is, yes. It's your stress hormones. And so your body is like, you know, which is, which is why people who have PTSD or experience chronic stress, their bodies will just shut down the stress response, because it will kill you.

Athena (00:39:45):
Oh!

Sarah (00:39:45):
Like if you have too much, it's so damaging because it's taking all the investment away from immune function, away from metabolism away from cell repair and just dumping it all to dealing with the stressor. And it makes your body fall apart, literally fall apart like zombie. [Athena laughs] And so, um-

Athena (00:40:04):
So that's actually the zombie apocalypse.

Sarah (00:40:06):
It is.

Athena (00:40:06):
We're falling apart because our cortisol responses are just-

Sarah (00:40:10):
Outrageously high. [Athena laughs] These folks wanted to look at whether women, um, who are on the pill exhibit these other signs that are associated with being overwhelmed by the stress response. And one of the things that happens, um, is, um, you get hippocampal shrinkage because that area of the brain, like I said, it has a number of receptors, probably more receptors than any other part of the brain for this hormone because it helps prime learning and memory in the context of stress.

Athena (00:40:36):
Hmm.

Sarah (00:40:36):
But if there's too much of it, it starts killing brain cells. It'll start killing cells in the hippocampus because, because it's so sensitive to cort, um, if there's too much of it they'll just go [Sarah makes explosion sound] and self destruct. And so they took brain scans in two different samples, and these were really large samples, um, I think it was, it was, it was over a hundred women. I feel like it may have been, it was like close to 200 women, um, 200 women in each sample.

Athena (00:41:01):
Okay.

Sarah (00:41:01):
So two separate samples. They did this, they did brain scans and they found that, um, that women, um, on the pill had hippocampal shrinkage. They relatively small hippocampi relative to women who are not on the pill, which again suggests that it's doing something that is causing the body to become overwhelmed by cortisol signaling, which is probably causing the body to actually shut down the stress response. And nobody really knows why.

Athena (00:41:26):
Do you have any speculations about that?

Sarah (00:41:29):
I do. Um, so I read, um, cause I was of course really intrigued by this.

Athena (00:41:34):
Yeah.

Sarah (00:41:34):
And like I said, I was like Encyclopedia Brown where I was like-

Athena (00:41:38):
Trying to piece it together.

Sarah (00:41:38):
Yeah, trying to piece it together. And then like, oh, okay, I think the body's actually getting overwhelmed by stress and then they're shutting it down and then dah, dah, dah, dah. And then I was like, well, why would it do this? And so my guess was that this, it probably has something to do with the progestins in the pill.

Athena (00:41:50):
Okay.

Sarah (00:41:50):
So um progestins are artificial progesterone. Um, and there's different versions of them. There's like four different categories of them.

Athena (00:41:59):
Mm hmm.

Sarah (00:41:59):
Um, and unlike, um, the artificial estrogen, which is in the pill, um, cause most, um, birth control pills have an artificial estrogen and an artificial progesterone, which is called the progestin. And the artificial estrogens are actually derived from estrogen and they're pretty, um, you know, the binding affinity to, uh, to estrogen receptors is high.

Athena (00:42:20):
Okay.

Sarah (00:42:20):
Um, meaning that, you know, they bind to estrogen receptors and like not other receptors.

Athena (00:42:24):
So they're acting in a pretty similar way that our body would be functioning.

Sarah (00:42:29):
Yeah. So they, yes, exactly. Um, the progestins are usually manufactured, most of them are manufactured with testosterone.

Athena (00:42:38):
Oh, really?

Sarah (00:42:39):
Yeah. And um and the binding affinity isn't great.

Athena (00:42:42):
Where do they get the testosterone?

Sarah (00:42:44):
I don't know where they get the testosterone. That's an interesting, that's an interesting, probably some guy in Cleveland [everyone laughs] providing all the testosterone. But testosterone is like a really modifiable molecule apparently. And um, and actually some of the reasons that women experience breakouts and stuff, um sometimes women will get hair growth, um, and stuff on the pill is because, um, is these these uh, artific-, these progestins, because they were created from testosterone, um, that sometimes they also have binding affinity to testosterone receptors. So it's actually turning on women's testosterone.

Athena (00:43:19):
So a bunch of our cells have receptors for testosterone and we have like really low super low levels usually, right?

Sarah (00:43:25):
Yes. Yeah.

Athena (00:43:27):
But then, you bring in these progestins and some of them are like "oh let me..."

Sarah (00:43:31):
Yeah they like, basically, you know, when you have an, a hormone, it's like going onto a receptor on the cell, basically. It's almost like putting a key into the ignition and turning it on.

Athena (00:43:39):
Hmm.

Sarah (00:43:39):
Right. So, um, this thing is able to, you know,

Athena (00:43:42):
It's like a master key, it's a bunch of locks.

Sarah (00:43:44):
It opens a bunch of locks, you know. [Athena agrees] And like, usually, you know, when you have progesterone in your body and it will only, it's a key, a bunch of keys floating around in your body and it'll only be able to turn the ignition of cells that have progesterone receptors, right? And then they'll do their thing that they do and progesterone's around. Um, but when you have something that a progestin that's also binding to testosterone, it'll go and turn on the ignition to all your cells and have testosterone receptors, and that can lead women to experience breakouts, and, um, you know,

Athena (00:44:13):
Hair in places they don't want.

Sarah (00:44:13):
Yes, hair in places they don't want, like embarrassing places and, um, but to get to the cortisol thing, um, I read a paper in a chemistry journal, which I don't recommend to anyone [they laugh] 'cause I was trying to figure out whether there was, 'cause the, these, um, like I said, these progestins are, their binding affinity is not perfect. I mean, cause they're monkeyed-with molecules and, um, and you know, and they, they do things that they might not, you know, should be doing. And in cort, yeah so in cortisol and progesterone are actually very similar structurally. Um, uh, in terms of a molecule. And so I was sort of interested in whether progestins might be doing something to cortisol receptors.

Athena (00:44:59):
Interesting.

Sarah (00:45:00):
So I did this research and I ended up having to read it and like I said, this chemistry journal and then I had to go talk to a chemist to make sure [Athena laughs] that I understand the language and I'm like, I don't know about this. But, um, long story short, the, um, there's some research showing that, um, some progestins will actually, um, they're close enough, they're similar enough to um, to uh, the two, uh, cortisol to sometimes bind to cortisol receptors.

Athena (00:45:34):
Really?

Sarah (00:45:34):
Yeah. And so the body may be getting overwhelmed by cortisol signaling from these progestins cause these progestins might be sort of turning on the body stress program, right? Like turning that key and making those cells run the stress program,

Athena (00:45:49):
Yeah.

Sarah (00:45:49):
Even though there's not actually, you know, like actual, actual cortisol in the system.

Athena (00:45:53):
Right.

Sarah (00:45:53):
It's the progestins making the body think that there's cortisol in the system leading it to, you know, but,

Athena (00:45:59):
And then the body kind of habituates almost.

Sarah (00:46:01):
Yeah, it does. And so it turns down the stress response, um, because it thinks it's being overwhelmed by stress-

Athena (00:46:07):
And there's like, not, like you're not actually getting the other signals that there is like legitimate stress around.

Sarah (00:46:14):
Right, like, like stress.

Athena (00:46:14):
So then it's like, I dunno, the detecting threshold moves around or something.

Sarah (00:46:17):
Yeah. No, that's really interesting because I hadn't even thought about that, but, um, maybe, wow, that's a really interesting idea. So what you just said, and you might not have meant it this way, but I think you did, um, was that experiencing a surge in like cortisol, the stress hormone, but you're not experiencing that in the context of, um, the other types of stress response, like your sympathetic response. [Athena agrees] So there's no epinephrine being released, only cortisol, that could be a signal to your body that, um, that it's chronic, that it's like a chronic stressor.

Athena (00:46:50):
Yeah. Well, and also that, you know, if you're not getting all the other cues that like, yes, this is a stressful situation, then it would make sense that you'd sort of habituate to that cortisol being higher and be like, okay, that's not a good cue [Sarah agrees] that the rest of the body should be responding to for creating like that stress response. It's not like crossing over like a threshold of like, Oh yeah, we should be responding to this.

Sarah (00:47:19):
Right. Yeah no, that's really interesting. That's super interesting idea cause it could, yeah. Yeah. So, um, yeah, I don't know. I don't know what the exact answer is, but my guess is that the, um, the progestins are being picked up by the cortisol receptors and making the body going into hyper stress mode and that the body is just like shutting it down.

Athena (00:47:39):
Yeah.

Sarah (00:47:39):
It said "alright, that's it. We're done, no more cortisol dumping tons of binding globulins into the bloodstream" and women who are on the pill do have tons of cortisol-binding globulins. A lot more than, um, naturally-cycling women.

Athena (00:47:51):
Huh.

Sarah (00:47:51):
Um, which is, which is why they don't experience that stress response because there's so much binding globulin that, um, that it just gets totally eliminated.

Athena (00:48:01):
Right. Well, and maybe that's like actually the mechanism for the like turning down of the detection threshold. If you put all these globulins out, then it's like we're not paying attention to the cortisol.

Sarah (00:48:12):
Yeah. That was all. Yeah, exactly. And that's, and that's exactly what it is. It's like we're not paying attention to that and like, what does that mean for women who are on the pill and what does it mean for their brains? I mean, it's certainly, you know, the hippocampus thing isn't great, but even just like, you know, given that cortisol sort of takes things from our short term memory. So just like our, you know, our RAM, you know, our-

Athena (00:48:31):
Uh huh.

Sarah (00:48:31):
What we're thinking about, what we're going through and shuttles it into, you know, our long-term memory. Um, I feel like it could make our lives feel more flat.

Athena (00:48:41):
Right.

Sarah (00:48:41):
You know, because it's like nothing feels meaningful.

Athena (00:48:44):
You're not encoding anything.

Sarah (00:48:45):
Yeah. And things aren't being flagged as being biologically meaningful.

Athena (00:48:48):
Yeah.

Sarah (00:48:48):
And does that make us feel like life isn't meaningful?

Athena (00:48:51):
Like lil' zombies just...

Sarah (00:48:53):
Yeah, like black and white and that's, 'cause you know, I kept thinking about my own experiences, uh, when, when I went off the pill feeling like all of a sudden the world got more three dimensional and it felt like there were more opportunities and you know, I was like more vibrant and dynamic, and I wonder whether part of that wasn't what was going on with my, um, stress response and that I just, like nothing was being flagged in my brain. [Athena agrees] Like, pay attention to that, Sarah. Like that's where, you know, like, that's interesting. Or like, you know, [Athena agrees] wow, that's a meaningful event.

Athena (00:49:24):
Yeah. Well it's almost like if we're going to consolidate from day to day our experience and say, okay, here's something that tomorrow I should spend more of my bandwidth on.

Sarah (00:49:34):
Right.

Athena (00:49:35):
Or tomorrow I should spend less 'cause it's not important, right? Like in order to do that, you have to have some mechanism for following up. Right? Like, you know? [Sarah agrees] I should wake up tomorrow morning excited about this thing or whatever.

Sarah (00:49:46):
Yeah. And like and the ability to adapt, you know, and like, do like I recognize this situation as this and I can now do a better job at coping than the first time I encountered this scenario. And so, um, yeah, that for me was one of the more, um, surprising things that I read about. There was, um, you know, the effects in terms of the way that it influences our other brain systems is really pervasive. And, um, because there's research showing that it influences, um, oxytocin signaling.

Athena (00:50:20):
Oh yeah?

Sarah (00:50:20):
So oxytocin is, um, you know, the chemical, it's like the, you know, bonding hormone, affiliation hormone is the-

Athena (00:50:28):
The love hormone, the cuddle hormone, the sex hormone.

Sarah (00:50:31):
Yeah. It's all about like your, well, it can also be that prejudice hormone.

Athena (00:50:38):
Right, the in-group favoritism hormone. Yeah.

Sarah (00:50:38):
Yeah, the in-group favoritism hormone. Um, but, um, there's some research showing that it interferes with the regular oxytocin signaling pattern.

Athena (00:50:45):
When you say it, you mean-

Sarah (00:50:47):
The pill.

Athena (00:50:48):
In general, or do we know what parts of it?

Sarah (00:50:50):
No, we don't know what parts-

Athena (00:50:51):
Okay.

Sarah (00:50:51):
We just know that women, that women who are on the birth control pill, like normally when you, um--here was what they did with the study--um, they gave people intra-nasal oxytocin. Um, which, um, you know, so people are basically snorting, [everyone laughs] snorting, um, doing lines of oxytocin. Um, and then they would show people pictures of their romantic partners and then they would take brain scans and, um, in addition to showing them pictures of their own romantic partners, they were showing them pictures of like random strangers and stuff. And, um, and what you generally find is you shoot somebody up with oxytocin, um, and you show them a photograph of a loved one, um, and their brain like has a firework show.

Athena (00:51:35):
Hmm!

Sarah (00:51:35):
Oh, that's my person! Yay!

Athena (00:51:38):
Um, or for some people their dog.

Sarah (00:51:41):
Yeah, with their dog. I'm sure it would do the same thing, but like you don't get that with strangers, you know, it's just like these, um-

Athena (00:51:48):
Makes sense.

Sarah (00:51:48):
Our close people. Um, and with the pill-taking women, nothing. Intra-nasal oxytocin-

Athena (00:51:54):
What?

Sarah (00:51:54):
Show them a picture of their romantic partner, their brains didn't do anything different than they did when looking at a stranger and like, here's why this is, here's why this, there's so much provocative research out there on what this does and we don't know why, but why this is particularly provocative, um, at least when, when I was thinking about this research and context, um, is I was thinking about children and babies. And so one thing that we know is that oxytocin is released in like copious quantities when, after you give birth. Um, it's like, you know, breastfeeding, all that releases oxytocin, um, you know, holding, cuddling a baby, oxytocin. And, um, the reason that our brain is releasing oxytocin in these contexts is because bonding with your baby is like really important obviously.

Athena (00:52:38):
Right.

Sarah (00:52:38):
And, um, and it's part of the evolutionary mechanism to help keep us, you know, bonded to our children. Most doctors, um, we'll put you on the birth control pill right after you have a baby cause they don't want you getting pregnant right away.

Athena (00:52:51):
Wow.

Sarah (00:52:51):
So now imagine you are a woman who's on the birth control pill. Um, and even if you're breastfeeding like they put me on because I brought my, both my kids, um, they put me on a progestin-only birth control pill, and the progestins are the things that are doing the funky stuff. You know, I mean.

Athena (00:53:06):
Wow.

Sarah (00:53:06):
There's just no question in my mind about who the moneymaker is and all these weird effects and said dresses and, um, you put these women on the pill and their brains are releasing all this oxytocin because it's so important in bonding and if that's not causing your brain to experience neural fireworks when holding your baby, like could that play a role in all the postpartum depression we're seeing?

Athena (00:53:28):
Wow. Yeah.

Sarah (00:53:28):
Because women aren't feeling bonded?

Athena (00:53:31):
Yeah.

Sarah (00:53:31):
'Cause that could really interfere with that. And um-

Athena (00:53:34):
Because getting zombified by your baby is actually-

Sarah (00:53:37):
So important!

Athena (00:53:37):
Really important.

Sarah (00:53:38):
Super important. [Athena agrees] And so, um, you know, some of the implications of that research, um, in terms of what that means for women's health, and is anybody studying this right now? No. Like do we like, do people need to be studying this right now? Absolutely. Absolutely. Like we need to, um, ask for this research because, um, postpartum depression is a huge, huge issue for women's health and it's something that a lot of women struggle with and it increases. It's been increasing, you know, um, for a very long time now. And we just keep seeing that the rates of it go up. And, um, I think that this could be something that's really important to look into.

Athena (00:54:17):
Yeah. So, there's not really like anything functional really going on here in terms of like, oh, it would make sense for the body to respond to the sex hormones in this or this way. It's really, you think it's just a byproduct of the fact that these progestins are having these widespread effect?

Sarah (00:54:33):
Yeah. Yeah. And you know, it's interesting that you asked that question because I actually started when I started my idea to write this book I was reading these papers. Um, my thought was that the body was just running its luteal phase program all the time. So like when a woman,

Athena (00:54:49):
So more what you mean...

Sarah (00:54:49):
Oh yeah, I'm going to.

Athena (00:54:49):
Okay.

Sarah (00:54:49):
So, uh, when, you know, uh, the way that the birth control pill works is it, um, makes you take these artificial sex hormones, which are, um, they have like a sort of high ratio of, um, progestins to estrogen. It's, um, it's basically sending a signal to your brain that you're in the luteal phase of your menstrual cycle, which is the second half of your cycle. Um, and this is the part in the menstrual cycle where the body isn't, um, having to release sex hormones. Your body is like basically turning off the precursor hormones that lead to, um, you know, uh, egg development and then, um, you know, hormone released by your ovaries. Um, so the, these artificial hormones tell your brain to stop releasing precursor hormones.

Athena (00:55:36):
Yeah.

Sarah (00:55:36):
Or to, you know, create sex hormones. 'Cause we've already got, you know-

Athena (00:55:40):
It's also like when you could be pregnant, right? Am I right about that or-

Sarah (00:55:44):
It actually, no.

Athena (00:55:44):
Oh, okay.

Sarah (00:55:44):
It really looks more like the, well I guess you could be preg- 'cause usually, I mean it all happens during the second half of the cycle.

Athena (00:55:51):
Yeah.

Sarah (00:55:51):
Um, so it's basically telling the body that, um, it tells the brain to stop releasing precursor hormones.

Athena (00:55:58):
Yeah.

Sarah (00:55:58):
So that way the body's not creating its own sex hormones.

Athena (00:56:01):
Okay.

Sarah (00:56:01):
It's sort of the, the like, you know, um, USA Today version of what, what goes on. Um, and so these hormones tell the brain, don't release precursor hormone. So the body's own levels of hormones are really low. There's these artificial hormones that, um, are associated with the phase in the cycle where an egg is not being developed and fertility is basically just sort of stopped.

Athena (00:56:25):
Okay.

Sarah (00:56:27):
Okay. So are we good on...?

Athena (00:56:27):
Okay. So the pill usually just kind of has you standing still in a luteal phase, [Sarah agrees] which is like, that's after you would have ovulated?

Sarah (00:56:39):
Yeah, it's after you've ovulated. [Athena agrees] because like before you ovulate your levels of, um, like prior to ovulation, your levels of estrogen begin to increase. But progesterone, that other hormone is really low [Athena agrees] cause progesterone actually gets the, most of it gets released by this little temporary structure that forms once an egg is released.

Athena (00:56:57):
Okay.

Sarah (00:56:57):
So once an egg is released, um, the, the follicle that it was hanging out in-

Athena (00:57:01):
Yeah.

Sarah (00:57:01):
Actually starts releasing this hormone progesterone, um in copious amounts and, um, and so whenever you have high levels of progesterone, um, relative to estrogen, that's a phase in the cycle where an egg is just out there.

Athena (00:57:13):
Right.

Sarah (00:57:13):
- and the body's waiting to see what happens.

Athena (00:57:15):
Right.

Sarah (00:57:16):
Alright, we're just going to hang out and put our feet up, [Athena agrees] see whether or not that thing gets fertilized. And-

Athena (00:57:22):
Yeah. But then progesterone is like pro-gestation?

Sarah (00:57:24):
Right.

Athena (00:57:25):
So like it actually, if it's high, it can encourage a pregnancy to stick around.

Sarah (00:57:31):
Right. Yes.

Athena (00:57:32):
If it's, yeah.

Sarah (00:57:32):
Yeah. It gets the body, like it gets the body ready to um, to have an egg implant.

Athena (00:57:37):
Yeah.

Sarah (00:57:37):
It's like the implantation phase,

Athena (00:57:39):
Okay.

Sarah (00:57:39):
You know, the cycle. And so it makes you kind of sleepy and relaxed,

Athena (00:57:43):
Huh.

Sarah (00:57:43):
so that way you don't go out and like go bungee jumping. [Athena laughs] And it's kind of like I, in my book, I refer to it as like the mom jeans part of the cycle.

Athena (00:57:51):
Huh.

Sarah (00:57:51):
It's like the Earth mother, [Athena laughs] it's really about like, you're, you're hungrier, you're sleepier, you're basically doing all of these things that your body is like, just like, like, let's see if this, um, this egg that I released that maybe got fertilized, is going to implant. It's like all about implantation.

Athena (00:58:10):
So those are like the days when I want to like go home and make a steak and then go to sleep early.

Sarah (00:58:13):
Yes.

Athena (00:58:13):
Okay.

Sarah (00:58:14):
That, that is, yes, that is luteal phase to me right there. [everyone laughs] And, um, and so you know, that these hormones, my, so my original idea about what may be going on with the pill is that women would just be acting like women in the luteal phase, you know? You're sleepy and...

Athena (00:58:28):
Right, that would be like the first place to start.

Sarah (00:58:30):
Yeah. And hungry and you know, and all of this. And, um, but then when I actually got into, you know, so that was like sort of an evolutionary like here's what's happening and it's gonna be functional-

Athena (00:58:41):
Mm hmm.

Sarah (00:58:41):
And you know, whatever. But then I actually got into the neuroscience of it all and it was like, Oh no, this stuff just mess-, like these things are not running a normal brain program. Like, like they are running a different brain program, [Athena agrees] a totally new brain program that hasn't been observed in nature. So this is like not, you know, [Athena agrees] this is not a normal brain program.

Athena (00:59:03):
Mm hmm.

Sarah (00:59:03):
And so then it was like trying to figure out what version of women does it make them. It doesn't make women into, you know, they're not going to be there for like the estrogen dominant version of themselves, which is the sexy, fun, [Athena agrees] flirtatious version of themselves or the, you know, the luteal phase version of themselves, which is kumbaya mom jeans. [Athena laughs] It's going to make them into this zombie, right? [Athena agrees] This is like his zombified version of themselves because it's a totally different [Athena agrees] set of, you know, rules for the brain.

Athena (00:59:33):
Where they're like feeling the stress, but they're not actually getting the benefits that usually you would have from experiencing something that's stressful. And then being able to like consolidate that and use that information.

Sarah (00:59:45):
Right. And it changes their mate preferences and some kind of funky ways that don't really seem to be serving functions like, um, they find that women who are on the pill, like men with more feminine faces, um, then women who are not, which, you know, and part of that is kind of similar to what you see the luteal phase because during the first half of the cycle, when estrogen is dominant, that's the, um like sort of follicular phase. Um, that is, you know, that's usually associated with a heightened preference for social dominance and masculinity and [Athena agrees] some of these, um, sort of swagger. [Athena chuckles] Um, yeah, I'm just like, I'm just basically telling you what I'm looking for in a romantic partner. [everyone laughs] So if you have all these qualities, I'll give my phone number at the end of the podcast. So, um, but like all of these, you know, different, um, all these different qualities, um, aren't as much preferred during the luteal phase and pill-taking women look a little bit more like luteal phase women in mom jeans kumbaya, um, version of themselves, uh, when it comes to the pill. But again, not exactly, it's a little different. [Athena agrees] It's a little different. And, um, so looking at the ways that it changes, um, and it, you know, this one's a little bit less interesting just cause everybody knows about it, but it, um, it changes, um, some of our neurotransmitter systems that regulate mood. Um, you know, which is why [Athena agrees] the idea that, you know, a lot of women, um, stop taking the pill because of mood related side effects.

Athena (01:01:15):
What are the mood related side effects?

Sarah (01:01:17):
Um, uh, anxiety and depression,

Athena (01:01:20):
Okay.

Sarah (01:01:20):
Um, and in fact, um, you know, especially for women who are um adolescents. So 15 to 19 year old women, the increased risk for depression and suicide is staggeringly higher than it is for women who are not on a pill. And this is-

Athena (01:01:35):
Wow.

Sarah (01:01:35):
Really powerful research done, um, over in Denmark where they have those health registries-

Athena (01:01:41):
Yeah.

Sarah (01:01:41):
That allows you to test on the whole population of people.

Athena (01:01:44):
Right.

Sarah (01:01:44):
And they've looked at, um, like the suicide rate of people who are prescribed the birth control pill compared to a control group of people who were not prescribed the birth con-, so it's basically all the women in Denmark on the pill, all the women who are not-

Athena (01:01:57):
Wow.

Sarah (01:01:57):
Um, cause they can look at what people were prescribed [Athena agrees] because they have these health registries. Um, and they find that especially for 15 to 19 year olds, the rates of depression, um, are significant, are significantly higher by, um, I forget what the magnitude is. In some cases it's like 200% higher.

Athena (01:02:14):
Oh, wow.

Sarah (01:02:14):
Um, and then women who are, um, than women who are not comparably aged and the suicide risk is something like three times greater. And so, um, it can really, especially on adolescent brains that are still developing, um, have a really powerful, and not positive impact on mood. It seems to, those mood effects seem to, um, sort of decrease, um, once women get a little bit older, like 20 and up, it's it's still, there's still a significant increase. So it's still something to look for, um, especially if for a woman who's on the pill. Um, but, uh, it's, it's not quite as staggering [Athena agrees] as is for the younger women.

Athena (01:02:53):
Does that whole suite of effects on mood have to do with a cortisol issue at all?

Sarah (01:03:00):
I think cortisol is a part of it. Um, I think that's definitely a part. Another thing that I think is going on is, um, what goes on with, um, levels of what's known as, uh, allopregnanolone.

Athena (01:03:11):
Yeah, I know what that is.

Sarah (01:03:12):
I'm, yeah, well just, um, I don't want to have to say it too many times, [everyone laughs] it's like a mouthful, but it's a, um, so it's a metabolite of progesterone. So when progesterone gets broken down in the body, it releases like sub chemicals.

Athena (01:03:26):
Okay.

Sarah (01:03:26):
And one of them is um, allopregnanolone and um, this, um, actually stimulates GABA receptors in the brain.

Athena (01:03:34):
Yeah.

Sarah (01:03:34):
So GABA, um, GABA is an inhibitory neurotransmitter. And what this means is, um, you know, our brains run on these neurotransmitters and there's kind of like two varieties of them, like sort of two main varieties. There's excitatory ones, which make our brain like super ready to, you know, that's like when we're really alert. It usually means we have excitatory neurotransmitters going on that our brain is like primed and ready to go. [Athena agrees] When we have inhibitory, um, neurotransmitters. This is what makes us feel kumbaya. Um, and anything that stimulates our GABA receptors, which is GABA is an inhibitory neurotransmitter, um, anything that stimulates those receptors is gonna make us chill out and relax. Um, this is actually why alcohol is so amazing.

Athena (01:04:20):
Huh.

Sarah (01:04:20):
It stimulates GABA receptors and that's like what makes us feels zen like, ah, or yoga also stimulates GABA receptors, meditation, um-

Athena (01:04:30):
So there's other options besides alcohol, is what you're saying. [Athena laughs]

Sarah (01:04:32):
Yeah. But, um, yeah, Xanax. Yeah. So Xanax, alcohol, um, meditation, yoga. All these things, um, stimulate these receptors. And so you kind of get a sense for the way that they make us feel, you know, [Athena agrees] um, and, uh, one of the things that stimulates these receptors, um, and helps regulate our mood is allopregnanolone this pro-, this progesterone, this progesterone metabolite. Um, and this is why during the second half of the cycle, during the luteal phase, we want to relax and hang out by the fire and, you know, kumbaya. [Athena agrees] Um, and, uh, what the research and the progestins that are in the birth control pills don't have the same effect. So when these birth control pills get broken down in the system, they don't release allopregnanolone. And so, um, and it's not just what goes on in women's cycle or in women's brains during the second half of the cycle. If you look at levels of allopregnanolone, um, even in the first half of the cycle, you know, so, um, during when progesterone isn't the dominant hormone, what you find, um, if you compare women who are in that estrogen-dominant phase of the cycle and progesterone is low and you compare those two women who are on the birth control pill, um, the women who, uh, are on the birth control pills have significantly lower levels of allopregnanolone than the non-pill-takers. Like a lot. I forget exactly what it is.

Athena (01:05:57):
Hmm.

Sarah (01:05:57):
I feel like it's like 170% last or something.

Athena (01:05:59):
Wow.

Sarah (01:05:59):
It's like some like crazy difference and um, and they looked at expression of allopregnanolone in the brain. You have to do that with mice. You can't do that with humans without [Athena agrees] a really bad thing happening. And, um, and they find that expression levels in the brain are actually, suggest that what goes, is going on in the peripheral blood, which is how they're testing levels in humans-

Athena (01:06:21):
Okay.

Sarah (01:06:21):
Is probably under-estimating-

Athena (01:06:24):
Oh my gosh!

Sarah (01:06:24):
What's actually going on in the brain. And so women who are on the pill, um, could a lot of the re, you know, sort of ID the, the current wisdom behind why they can experience these mood affects of anxiety, which then often will have to often times will lead to depression because you feel like you can't cope, [Athena agrees] is because the brain isn't, isn't chilling itself out [Athena agrees] cause it's lacking this, um, this important metabolite that plays a role in mood regulation.

Athena (01:06:49):
That makes sense. And I mean, and also makes sense that the whole cortisol thing could be playing a role because if like your body is getting, you know, all this like flooding with cortisol and then all the binding globulins to try to like clean it up. But like there's all this like weird signaling where it's like, oh, you should be stressed. Oh but, not!

Sarah (01:07:09):
But like, yeah, no. And then like not having things flagged as biologically meaningful. So life feels meaningless. You're stressed. [Athena agrees] You're not chilling out. I mean there's like so many things and are kind of working against us in terms of mood with this. And, um, you know, when research is tracked, like what, um, you know, uh, when women go on the pill, what is the likelihood that they're going to continue on the pill or how many women are going to discontinue it? And if they do discontinue it, why?

Athena (01:07:39):
Yeah.

Sarah (01:07:39):
And what they find is that about half the women who started the birth control pill discontinue it. I think it's half and it's somewhere in that ballpark. It's a pretty substantial number. Um, and of those who discontinue it, the number one reason of course, that they discontinue is because of side effects. Um, and the most common side effect that causes women to discontinue it is mood.

Athena (01:07:58):
Mmhmm.

Sarah (01:07:58):
And so, you know, the thing that usually makes people stop taking the pill is that how it makes them feel. Which is also kind of interesting in the context of my book because, um, you know, when you talk to women about the birth control pill, I don't know about your experiences, but I know every time I talk to women about the pill, the thing that we always talk is the way it made us feel. [Athena agrees] But yet there's no information from there, you know, until I read, until this book, [Athena agrees] I was like, why, you know, it really surprised me when I, when I sat and read this stuff and I was like, I need to write a book on this if there's not one, but there has to be one 'cause this is what we all talk about.

Athena (01:08:31):
But everybody knows from their experience that it has really substantial effects on us, right? [Sarah agrees] Anybody who's been on the pill? You know what I mean?

Sarah (01:08:38):
Yeah. Or they, or they had a friend who had an experience and um, [Athena agrees] and so we all talk about this and it's all very much a part of our like sort of consciousness as women. Um, and yet we haven't really been able to have our, like have our experiences edified by research. [Athena agrees] And I think that in some ways I'm like, my book is, is going to be edifying for women. I think it'll be important because I think that our doctors tend to, you know, write off like the way that we feel like, like treating our mental health [Athena agrees] like, it's a luxury, you know, that, um, that, you know, or a character flaw that like we want to be happy [Athena agrees] and feel good and feel vibrant and feel in tune with our sexuality. So there's another thing that like, sort of, um, I talk about in the book, is just like how much, um, you know, cause it influences women's, like feelings of sexiness and it'll also influence the sexual desire and all of these other things. [Athena agrees] And it's like, these are really important things. [Athena agrees] And, um, and, and especially, you know, um, let me think about that. We were, you know, sort of designed by this evolutionary process that puts sex as sort of like, you know, a priority one, you know. [Athena laughs] And so sex is like a really important part of like, feeling like who we are, is like feeling like a sexual person and like, and, and, um, and, and I think that our doctors, women's doctors, um, have really, um, and, and things have gotten better and there's a lot of really amazing doctors out there, um, but I think for a very long time they sort of trivialized, um, any sort of experiences that we might be having, especially with our sexuality and um, and like how important that is to feeling like a woman and feeling vibrant is like feeling in tune with your sexuality. And-

Athena (01:10:21):
Yeah, that makes a lot of sense. [Sarah agrees] And I mean it feels like there's also a really long time, and I don't know if this is changing or not, but where the pill would just be prescribed for like, oh, you have acne or your cycle is not typical or it was just-

Sarah (01:10:40):
Well it still is.

Athena (01:10:41):
Is it?

Sarah (01:10:41):
Yeah. It still is. Like people are being prescribed it for um, or just feeling like my period. Yeah. If periods are irregular, well guess what? You know, it's like your periods, especially when you're young and your sort of hormone axis is learning about your body. That's exactly what's going on is your sex hormone receptors in your brain are sort of figuring out how your body works. And so it's trying to, it's trying to figure out how much precursor hormone it needs to release-

Athena (01:11:07):
Mm hmm.

Sarah (01:11:07):
In order to get your ovaries to stimulate and whatever. So it's troubleshooting. [Athena agrees] And so during that, to be putting people on the pill when your body's learning about itself, like it's dumb, to start with, [Athena agrees] but um, you know, so like, yeah, putting women on it for irregular periods, or skin problems or just speaking or doing it to eliminate their period. [Athena agrees] You know, 'cause there's that whole idea that just, you know, you can take these five-month sequences or three-months sequences, um, just so that we don't have to bother with a period. Um, like, I think that, I'm hoping that this book will like sort of open our eyes to like, why that's a big deal. [Athena agrees] So I think that we've been really cavalier about it and I think that it's time that we, that we're more serious about it. [Athena agrees] And then we just sort of understand what we're doing. And it's not, it doesn't mean that that's terrible. And for some women that's still going to be the best decision, [Athena agrees] and that's their decision to make, but they need to be able to make that decision having all the information, and they just haven't been given that until now.

Athena (01:12:01):
Sure. Okay. So I have to ask, like, from doing all this research and seeing the effects of the pill, like what are like good ways for women to have that control over their reproduction? Like if they don't want-

Sarah (01:12:18):
Right, the pill.

Athena (01:12:18):
The pill.

Sarah (01:12:19):
Okay. Yeah. And let me just say that, um, you know, for some women, um, it's the, pill still can be the best answer. [Athena agrees] If you are at a time in your life when a pregnancy would be absolutely devastating, um, you know, I, um, I would like, if I were the person I was in my twenties, um, I would, I would still go on knowing everything I knew, I still go on the pill. Or now that I know about these other alternatives, which I'll talk about it. So I'm just, um, you know, I would either go on the pill or, [Athena agrees] um, you know, the copper IUD-

Athena (01:12:50):
Okay.

Sarah (01:12:50):
Is something that a lot of people seem to tolerate well. Um, so the copper IUD is the one that is non-hormonal. There are hormonal versions out there. Um, but don't let your doctor fool you about the hormonal ones. Like even though they are low levels of hormones and even though they're being administered, um, you know, in your, uh, cervix instead of, you know, with a pill, they go everywhere in your body. I had a doctor one time, tell me about the, um, about the, it's the Mirena, um, because the hormone levels are low and it's, you know, down in your cervix. Um, well, you know, it's, it's like the hormones are like more localized. Hormones go into your bloodstream and go everywhere. [Athena agrees] There's no such thing as localized-

Athena (01:13:36):
But your doctor, the doctor was trying to say-

Sarah (01:13:36):
But my doctor was like, yeah, this is like a more localized, which is, yeah, no, there's no such thing as a localized hormone effect. [Athena laughs] Um, anyway, yeah, I found a new doctor. And so, um, uh, the, um, the copper IUD, um, it is, like doesn't have hormones. And the only thing about the copper, some people have a not great reaction to this IUD just because, um--and this is rare--so like I, I would try the copper IUD, like-

Athena (01:14:04):
Mm hmm.

Sarah (01:14:04):
- um, it that is, um, I can get good at option, but my, like just only my one caveat that I want to say about it, um, to be sort of even-handed, [Athena agrees] is that, um, it causes an inflammatory response. So, um, the way that the copper IUD works, is they're actually not 100% positive. Isn't that interesting?

Athena (01:14:24):
They just know it works.

Sarah (01:14:26):
They just know it works, but they don't know exactly why, which is really interesting. Um, they, you know, what I think is going, I think that's something to do with the inflammatory responses going on -

Athena (01:14:36):
That would make sense.

Sarah (01:14:36):
- locally because your cervix and your uterus are basically like, huh uh, nope, we're, we're sick. [Athena agrees] [Sarah laughs] We're not accepting any delivery. [Athena laughs] Um, uh, fertilized eggs at the moment, [Athena agrees] come back later. Um, and so it, it does cause an inflammatory response and it's not like a huge inflammatory response, um, by women who are on it oftentimes have relatively elevated inflammation, especially, you know, localized inflammation. Um, but that can influence moods. Um, and so I've known women-

Athena (01:15:10):
Hmm.

Sarah (01:15:10):
who have gone on the copper IUD. Um, I've and, and let me again preface this by saying that I know more women who've gone on in the copper IUD had an amazing experience and I know this, but do you know some women who had mood side effects on the copper IUD, and they're like, why am I experiencing mood side effects? I'm like, it's inflammation, like says inflammatory activity, um, changes your mood.

Athena (01:15:34):
To make you feel depressed, right?

Sarah (01:15:34):
It can make you feel depressed and um, it can make you feel anxious and um, and so, uh, you know, even though it doesn't have hormones, it, there is still a chance that it could change what your brain is doing [Athena agrees] just because of its influence on the inflammatory response. And so that's like my only sort of caveat, but that's like if I was 20 year old me, that would be probably the thing I would try first. Um, or like, uh, you know, just going, um, going back on the pill, just 'cause not getting pregnant was so important. [Athena agrees] If you're at a time in your life where, um, it's a little bit less scary if you got pregnant, but you're still trying to avoid it, I think that just, you know, um using a tracking app, and to like [Athena agrees] know where you are in your cycle. Um, and then, um, just like using condoms during your fertile days is like a really nice possibility [Athena agrees] just in terms of like natural, you know, um, sort of family planning, um, and cause there's only really like five days or in the cycle when you can conceive. [Athena agrees] Um, and so that leaves you a whole lot of days of condomless sex,-

Athena  (01:16:35):
Right? [Athena laughs]

Sarah (01:16:36):
Which I don't think most of us are shooting for. [everyone laughs] Um, because it's like the worst, um-

Athena (01:16:42):
Yeah. It's also nice to know where you are, right? Like if you do the tracking and then you're like, oh, this is where I am in my cycle. And-

Sarah (01:16:49):
Yeah, no, I love, I love that. Like, um, I think that it's so cool now that women are able, like, we have these apps and you know, we're, we're able to learn more about who we are. And I think that, um, you know, a lot of women have sort of intuitively been picking up on like, Oh, I feel, you know, on these days, like I am, like, this is when I am a sex kitten. You know, [Athena agrees] it's like this day to this day is like usually, you know, um, and there's a lot of research showing that women have more sex, um, right, like when estrogen is high and they're feeling hot and sexy and um, and then later on in the cycle, they don't want to, they want to have the steak and bedtime. [everyone laughs] Yeah. And um, and so yeah, it's really nice knowing where you are and your cycle, um, in terms of understanding your mood and who you are a little bit better. [Athena agrees] It's kind of a, it's a really kind of a cool empowerful thing. So that's another possibility. You know, it's not a hundred percent foolproof. Obviously when you're doing something like that, there's, um, it's going to be a little bit of a higher error rate than there is with something like uh. You know, a copper IUD, which is why I wouldn't, like if I was, you know, in medical school.

Athena (01:17:55):
Right.

Sarah (01:17:55):
You know what I mean? I probably wouldn't, I would opt with something a little bit more fail-safe just cause I'm, you know, I tend to be a worrier and if it, [Athena laughs] and so, no, I'd probably go that route. But I mean, that's also like a really good route. Um, and I should probably start to research this a little bit more, but like, do they still make diaphragms? I was like, I don't know. People use those.

Athena (01:18:17):
I think so, but I don't know.

Sarah (01:18:18):
I think that's a thing that's probably a thing that people could do. [everyone laughs] It feels like a thing someone could do, [Athena agrees] um, to protect themselves against, um, you know, a pregnancy that they were hoping to have. That is, I think, a pretty decent, you know, a pretty decent rate. But, um, I'm hoping that science is going to give us something better. I'm hoping that we're going to get this thing locked up at some point [Athena agrees] in the next, you know, decade, two decades in a way that, um, sort of minimizes, um, you know, the sort of collateral damage within the body. It means, it was just tricky. I mean, this is a hard issue [Athena agrees] because our body is, you know, given that we were created by this evolutionary process of reverse engineering, it's messy. Like our body doesn't have like, you know, it's not like if you built something where it's like, well this wire does that and this cog does that. Instead, it's like this hormone affects everything [Athena agrees] and this molecule also affects everything. It's 'cause everything has been cobbled together through systems that were already in place through this messy evolutionary process. [Athena agrees] Everything's interdependent in her body. And so it's really hard to like. [Athena agrees] Target, target something because nothing can be targeted because it has all of these other things. [Athena agrees] And, um, so, but I'm hoping that, you know, I'm hoping that we're going to, something genius is going to happen [Athena agrees] and we're going to have this thing locked up because I do think, you know, regulating our fertility is like so important for women and it sounds so much for us in terms of our ability to support ourselves, keeping ourselves out of poverty, keeping ourselves from having children that go into poverty. Um, it's really been a game changer. It's been a great thing for women that way.

Athena (01:20:00):
Yeah. Well and it's kinda cool how, you know, you're coming at it from an evolutionary perspective and then with the, that kind of like opened up this whole other realm of like the complexity of what's under the hood. [Sarah agrees] 'Cause I think often like with evolutionary perspective, we think about like, oh the design of the system and like how it's working. And it can be a little simplistic in terms of how like, like [Sarah agrees] the first attempt at approaching it, but then the, the neuroscience really just like opened up this whole realm of like what the mechanisms are and how you're getting all these like different effects that you wouldn't [Sarah agrees] be able to hypothesize from just an evolutionary perspective without knowing about how the mechanisms are working.

Sarah (01:20:43):
Right, right. Which is why sharing brains is like, is like so important [Athena agrees] because the ability to really understand the most vexing problems and like, you know, human nature and everything else is, it's dependent on our ability to borrow from, is to consume other people's brains, [Athena laughs] seek different perspectives and sort of apply them to these vexing problems.

Athena (01:21:07):
Right. We'll only really be able to understand brains if we share our brains [Sarah agrees] in order to learn about all the things that we need to learn about in order to decode them, I guess.

Sarah (01:21:21):
Yeah, exactly. No, I totally agree.

Athena (01:21:22):
Okay. So any words of wisdom here for the zombie apocalypse? So usually like at the end of the episode I ask like, you know, if we sort of take the zombification that we've been talking about here, which I guess would be like being zombified by being on the pill.

Sarah (01:21:38):
Yes.

Athena (01:21:38):
And you take like those effects and you ramp them up like even higher, then what kind of a zombie apocalypse are we in? And like, you know what I mean? Like if everybody was affected by hormonal contraception and that kind of way, but like even more where like we couldn't have a stress response.

Sarah (01:22:03):
Right.

Athena (01:22:03):
- as effective and like, what zombie apocalypse is that?

Sarah (01:22:08):
What zombie apocalypse? So I'll tell you, how about this. How about I answer, I'm going to answer the question, but my answer, like, let me tell you the zombie apocalypse that's already going on.

Athena (01:22:18):
Go for it.

Sarah (01:22:18):
Can I tell you this is, [Athena agrees] this is, this is the birth control pill does not just zombify women. It has zombified men. And so I'm convinced that-

Athena (01:22:29):
Just gave me the chills.[Athena laughs]

Sarah (01:22:33):
I know. So um, we know that one of the most powerful motivators of any sort of behavior for men is women. Right? [everyone laughs] So, like getting sexual access to women has been the reason that men have done everything that they've done in history right there. There's a reason there's a muse. Like a muse is a thing because women inspire men to do great things, right? It's allowed them to build cities and sky- skyscrapers and whatever and whatever. Most things that men have done that are impressive and noble are, because they were really hoping to get laid [everyone laughs] In fact, Aristotle Onassis once said, if there was no women, all the money and power in the world would be meaningless.

Athena (01:23:17):
Hmm.

Sarah (01:23:17):
Think about that. It would be, men wouldn't care about it anymore. So this is coming back to the pill.

Athena (01:23:22):
I don't know. I wouldn't mind to have some power and resources.

Sarah (01:23:25):
No women! No to men.

Athena (01:23:27):
Okay.

Sarah (01:23:27):
But, women, the reason that, because we like it, right? Like I would, I would still want it to, the men don't care. Men only like men want power and resources for access to women. So if you removed women, men wouldn't care about it anymore. We still would, we'd go shopping. [Athena laughs] I'll get those cute boots that you bought today. [everyone laughs] So um, so women are various powerful source of motivation to men and there's just no question about it. There's tons of research that shows that this is, that this is the case. So the birth control pill, has sort of opened this new area of sexuality for women, right? We can go and have sex and we don't need to worry about whether some guy's going to be somebody who's worth keeping around, right? If he's kind of cute and he's fun, we're having a good time, we can have sex with him if we want to. So basically sex has become, um, something that's a lot easier to come by now for men than it used to be. Um, and I think that the birth control pill is actually zombified men's brains and made them totally unmotivated to achieve anything because they no longer have to, in order to get laid. I think the reason [Athena laughs] that men are not graduating from college or even going to college at the rates that they used to, that men aren't getting good jobs at the rates that they used to, 'cause if you look at the trends,-

Athena (01:24:42):
Uh huh.

Sarah (01:24:42):
It's not just that women are doing better, men are actually doing worse.

Athena (01:24:45):
Hmm.

Sarah (01:24:45):
So men have started to sort of decline in their college graduation rates, their, um, applications to advanced degree programs and men are, again, if you look at the trends is not just women, you know, are sort of doing better. Women are doing better, but men are doing worse. And I think that one of the reasons that men are doing worse is that their brains are zombified by the fact that they can get laid despite the fact that they are living in their mom's basement [everyone laughs] and are playing video games all day. So I think that, I think that men are, that they're demotivated.

Athena (01:25:24):
But there's also like a whole, like there's this whole incel phenomenon too, right? [Sarah agrees] The guys who are living in their mom's basement and can't get laid [Sarah agrees] and are really frustrated and angry about that,

Sarah (01:25:37):
Right. Yeah, no.

Athena (01:25:39):
And they feel like they should be getting laid and they're not.

Sarah (01:25:41):
So yeah, those are like entitled assholes. [Athena agrees] Um, but yeah. Anyway, so I think that, um, I think that the, the pill has, uh, can zombify um, men's behavior. Um, it can zombify men's brains by changing the behavior of women, which changes, um, then the behavior of, um, men, and it probably is going to zombify the world because think about this for a minute. Women, you know, now that we have the pill and it's, uh, the women are sort of postponing getting married 'til later 'cause of course they can. And all of this, um, there's more, um, you know, that means that people are single longer, [Athena agrees] right? And before they're getting married, which means that there's going to like increase the need for like single person housing because there's many more people living in those things for a longer period of time.

Athena (01:26:33):
Okay.

Sarah (01:26:33):
But it'll probably increase the demand for interesting things in cities like museum exhibits and things that people do when they're single. [Athena agrees] Right. And so I think that the pill, probably by changing, you know, sort of the tempo of life and making people all single longer, allowing women to, cause you know, there's a, there's a really great book by Rebecca Traister called "All the Single Ladies," [Athena agrees] and there's been a real big rise in the number of women who are just like not getting married and it's, 'cause we don't have to. [Athena agrees] And, um, and you know, the pill has played a really instrumental role in a lot of this. And so, you know, it's changing societies and then that's going to change the kind of jobs that get created. And it'll probably change the demand for things like organic arugula, [everyone laughs] and you know, so it's probably, you know, zombifying the world.

Athena (01:27:16):
I mean it sounds like a pretty good zombie apocalypse.

Sarah (01:27:19):
I know it was amazing one with all the arugula, [Athena laughs] you know, you can imagine. So, yeah. But like I think that the pill is probably zombifying the world.

Athena (01:27:30):
So we're, we're in the zombie apocalypse-

Sarah (01:27:32):
We are.

Athena (01:27:32):
of the birth control pill. Some aspects of it are problematic. Other aspects are not at all.

Sarah (01:27:38):
Exactly. Those are amazing. It's like everything, you know, everything cuts both ways. [Athena agrees] I don't think that there's anything out there that doesn't cut both ways, and the birth control pills is no exception to this. [Athena agrees] Some good, some bad.

Athena (01:27:50):
Sarah, thank you so much for sharing your brains with us on Zombified.

Sarah (01:27:54):
Yeah, thanks for listening.

Theme (01:27:56):
[Psychological by Lemi]

Athena (01:29:13):
Zombified is a production of Arizona State University and the Zombie Apocalypse Medicine Alliance. Thank you to the Department of Psychology, the Interdisciplinary Cooperation Initiative, and President's Office at ASU, and the Lincoln Center for Applied Ethics. Also, thanks to all the brains that helped make this podcast: Tal Rom, who does our awesome sound, Neil Smith, our amazing illustrator, and Lemi who is the creator of the song "Psychological." Thanks also to the Z-Team, our undergraduate team who works on many aspects of the podcast including creating the transcripts. Follow us and support us. You can find us on Instagram and Twitter, at ZombifiedPod and on Facebook we are Zombified Podcast. Our website is zombified.org. Also, you can support us by going on Patreon and giving $1 a month. We have no ads and we're totally an educational podcast. So your support would be greatly appreciated. And if you can afford $5 a month, that would be even more awesome. You can also support us by buying merchandise. Um, t-shirts and stickers are available on our website and all of the proceeds go to support Zombified Podcast.

Athena (01:30:32):
At the end of each episode I share my brains. I offer something, a story, sometimes a connection to my work or a wild speculation or just some reflections from the episode. So today what I wanted to offer is some reflections on, um, the things that Sarah was saying at the end of the episode. I mean they were her speculations, but I want to offer some of my own. Um, she was talking about how she thinks it's easier for a lot of men to have sexual opportunities now because birth control exists. And I was thinking about this and I wonder if it's not that overall, um, men have more, or that is not that every man has more sexual opportunities, but maybe there's actually a skew where certain men have more sexual opportunities. So the idea is, you know, if women are seeking more sort of short-term sex for pleasure and gratification because birth control is available, then it seems like the sexiest guys might end up having a larger proportion of the overall sex that's happening. And if that's what's going on, um, then it would actually make sense that a large proportion of men who aren't being chosen as these short term sex partners, um, might be getting frustrated. Now, of course, that's not okay for anybody to act entitled to get sex or get angry at women that they aren't getting sex. But I do think that it's important for us to understand, you know, if there are patterns, um, that we should just know about. We should take a direct look and see exactly what's going on. So I'm not a sex researcher, but somebody who is should look at this and maybe there is already work on this. Um, if you know of some of it, definitely tweet it and tag ZombifiedPod so that we can share and, um, potentially have an opportunity as a community to put our brains together to understand, um, what is going on.

Athena (01:32:46):
I actually think the whole issue of, um, the incels issue and if, um, you know, there are people who feel like they are not having sex and it's not because they don't want to have sex, but because they don't have an opportunity, that that's something that we should at least be looking at as, um, something that could be, um, there could be some societal solutions. There could be some ways that we can think about, you know, how to, um, reduce inequality of, um, sexual opportunities, obviously, without, um, infringing on anybody's autonomy. So it's complicated. But, um, I just wanted to put that out there because I think it is a really complex issue, um, and something that we should be taking seriously. So with that, I want to thank you all for listening to Zombified, your source for fresh brains.

Outro (01:33:54):
[Psychological by Lemi]