Hill distinguishes the non-hormonal copper IUD from hormonal IUDs and recommends the copper option for women willing to use it, while noting heavier cramping and bleeding. She rejects the claim that hormonal-IUD hormones act only locally because hormones enter the bloodstream and can reach the brain.

Copper IUDs do not have hormonal effects
They can increase cramping and bleeding
Hormonal IUDs can suppress ovulation, especially early in use
Hormones circulating in blood are not confined to one location

“The copper one doesn't have the hormonal effects, right?”
Dr. Sarah Hill · 21:30

“there's no such thing as a locally acting hormone. Hormones go into the bloodstream and they go everywhere that blood travels.”
Dr. Sarah Hill · 23:30

#iud#copper iud#birth control#hormones

Myth Buster1:12:00

Why Birth Control Pills Are Not Equivalent to Menopause HRT

Hill distinguishes synthetic progestins in birth control pills from micronized progesterone used in hormone therapy. She says micronized progesterone can produce allopregnanolone, a neurosteroid associated with calm, neuroplasticity, and mental-health benefits, while synthetic progestins do not provide the same metabolite or full hormone benefits.

Synthetic progestin is not biologically identical to progesterone
Progesterone breakdown produces allopregnanolone
Hill links that neurosteroid with calm and neuroplasticity
Birth control pills and menopause hormone therapy are not interchangeable

“the synthetic uh progesterone in birth control pills that progesterine isn't biologically identical to progesterone the way that micronized progesterone is.”
Dr. Sarah Hill · 1:12:30

“the answer is no um because you don't get all those great benefits and it does you know tend to have this side effect profile…”
Dr. Sarah Hill · 1:14:00

#menopause#hrt#progesterone#progestin#allopregnanolone

Hot Take· 2

Hot Take37:00

Five Forces Hill Says Are Driving the Mating Crisis

Hill offers a multi-cause hypothesis for declining dating, sex, and relationship formation. She points to endocrine disruptors and hormonal birth control reducing desire, online pornography providing a low-effort substitute, women's educational gains narrowing the pool that meets hypergamous preferences, and dating apps keeping successful men in the dating market longer.

Lower testosterone may reduce sexual motivation
Hormonal birth control can suppress women's libido
Pornography may substitute for effortful courtship
Educational asymmetry can shrink the pool women consider
Dating apps may delay commitment among highly desired men

“I think that there's a few things happening.”
Dr. Sarah Hill · 38:00

“And I think that what that has created is made it really easy to find partners.”
Dr. Sarah Hill · 40:30

#dating#libido#pornography#online dating#hypergamy

Hot Take46:30

The Uncomfortable Predictor of Women's Upward Mobility

Hill recounts research on which factors predicted movement beyond a person's class of origin. In the study she describes, physical attractiveness was the strongest predictor for women and outweighed existing family socioeconomic status, educational level, and career choice.

The study examined movement beyond class of origin
Physical attractiveness was the strongest predictor for women
It reportedly outweighed education, career choice, and family status
Hill calls the result depressing rather than desirable

“the strongest predictor for women for upward social mobility was their physical attractiveness.”
Dr. Sarah Hill · 47:00

“this played a greater role in their ability to transcend their social class of origin than their family's existing socioeconomic status, their education level in…”
Dr. Sarah Hill · 47:30

#attractiveness#social mobility#gender#research

Explainer· 6

Explainer07:00

How Estrogen and Progesterone Shape the Natural Cycle

Hill describes the first half of a natural menstrual cycle as a rise in estrogen leading toward ovulation, with greater sexual desire, energy, and attention to mating cues. After ovulation, progesterone rises while hunger, sleepiness, lower energy, and emotional sensitivity become more prominent.

The first day of menstruation marks the start of the cycle
Estrogen rises as egg follicles mature before ovulation
High and rising estrogen corresponds with greater sexual motivation
Progesterone dominates much of the post-ovulation phase

“when estrogen is high and rising, like getting close to ovulation, women experience increases in sexual desire, they feel sexier, they have more sex, they're…”
Dr. Sarah Hill · 08:00

“During this time women are hungrier, they're sleepier, their energy levels are lower.”
Dr. Sarah Hill · 09:30

#menstrual cycle#estrogen#progesterone#ovulation

Explainer10:00

The Pill Replaces a Cycle With One Daily Hormonal Message

The birth control pill suppresses ovarian stimulation, ovulation, and the natural release pattern of estrogen and progesterone. Hill says the repeated synthetic hormonal message produces a flatter state associated with lower desire, lower energy, more sleepiness, and greater depression risk rather than the natural cycle's changing highs and lows.

The pill tells the brain not to stimulate the ovaries
Ovulation and natural hormone fluctuations are suppressed
A synthetic progestin and relatively low estrogen repeat daily
The resulting state differs from a naturally cycling pattern

“So you take this pill and it tells your brain do not stimulate your ovaries, right?”
Dr. Sarah Hill · 10:00

“every day women get the same hormonal message.”
Dr. Sarah Hill · 10:30

#birth control#hormones#progestin#libido

Explainer26:00

How Scent May Carry Hormonal Attraction Cues

Hill defines pheromones as chemical signals that affect another organism's behaviour. She cites research in which men prefer shirts worn by ovulating women and show a testosterone increase in response to ovulation scent, while high-estrogen women appear more sensitive to compounds produced as men's bodies break down testosterone.

Chemical signals qualify as pheromones when they alter behaviour
Men in cited studies preferred scents from high-fertility phases
Ovulation scent was linked with a testosterone response in men
The pill may reduce production and detection of attraction-related cues

“men actually in get a little increase in testosterone in response to the scent of ovulation.”
Dr. Sarah Hill · 26:30

“They'll like smell t-shirts worn by women who are ovulating and they prefer the scent of the ovulating women compared to t-shirts worn by the…”
Dr. Sarah Hill · 26:30

#pheromones#scent#attraction#testosterone

Explainer50:30

Why Pairing Off Can Change Female Friendships

Hill frames attractiveness as a major domain of competition among women when desirable mates are scarce. She says pairing off reduced that pressure in her own friendships, while becoming single after divorce made her appear threatening within a married social circle and contributed to her exclusion.

Scarce desirable resources create competition
Attractiveness is a major arena of mate competition among women
Pairing off can lower perceived rivalry
A newly single friend may be treated as a threat in married circles

“one of the primary areas in which they compete is attractiveness.”
Dr. Sarah Hill · 51:00

“you become very much a threat”
Dr. Sarah Hill · 52:00

#female friendship#competition#divorce#relationships

Explainer1:06:00

Why the Same Weight Training May Build Less Muscle on the Pill

Hill says hormonal birth control can reduce lean-muscle gains from weight training by keeping testosterone low. She describes research in which women following the same training regimen gained significantly less lean mass when using hormonal birth control than naturally cycling counterparts.

Testosterone helps initiate muscle-building processes
Hormonal birth control keeps testosterone levels low
The cited comparison held the training regimen constant
Pill users gained less lean muscle in the described research

“it can actually decrease your ability to put on muscle mass from weight training.”
Dr. Sarah Hill · 1:06:00

“women who are doing weight training, doing the exact same regimen compared to women who are naturally cycling, they put on significantly less lean muscle…”
Dr. Sarah Hill · 1:06:00

#muscle#weight training#testosterone#birth control

Explainer1:07:00

The Pill's Link to a Blunted Cortisol Stress Response

Hill argues that short cortisol surges are adaptive because they mobilize energy and support learning from stress, unlike chronic cortisol exposure. She says women using hormonal birth control show a flatter cortisol response resembling patterns also seen after PTSD or childhood trauma, though the exact mechanism remains uncertain.

Acute cortisol bursts help the body respond to stress
Chronic cortisol exposure is a different and harmful pattern
Pill users show a blunted response in the research Hill describes
Researchers suspect synthetic progestins may stimulate cortisol receptors
The precise mechanism is not established

“having big bursts of cortisol when we're stressed out is actually very adaptive and it's like part of how our body helps to manage stress…”
Dr. Sarah Hill · 1:07:30

“they have a really flat blunted response to cortisol in response to stress.”
Dr. Sarah Hill · 1:08:00

#cortisol#stress#birth control#emotional regulation

Story· 1

Story18:30

The Strip-Club Study That Tracked Fertility and Tips

A study asked dancers to record hormonal birth-control use, menstruation, and daily earnings across two cycles. Naturally cycling dancers showed a sharp earnings rise around high fertility, while pill users' earnings stayed flatter; Hill says the study could not identify whether scent, movement, clothing, or another cue drove the difference.

Dancers kept daily records across two menstrual cycles
Naturally cycling women earned more around high fertility
Pill users' earnings were comparatively flat
The study did not isolate the causal attraction cue

“for women who are naturally cycling, so again experiencing their own hormones, you get this really sharp increase in tip earnings that are corresponding right…”
Dr. Sarah Hill · 19:00

“We just have no idea um exactly what it is. But men seem to be picking up on it.”
Dr. Sarah Hill · 20:00

#fertility#attraction#research#estrogen

Tool· 1

Tool56:00

The Shared Dating Spreadsheet That Turned Rivals Into Scouts

Hill and her close single friends used a spreadsheet to trade notes about dates and redirect good matches who were not right for one member of the group. Their collaborative approach turned each date into information for the whole group rather than treating every other woman as competition.

Friends recorded and compared dating experiences
A poor fit for one person could be a strong fit for another
Side conversations helped create introductions
Shared information expanded the group's effective dating pool

“we had a spreadsheet when we were dating.”
Dr. Sarah Hill · 56:00

“maybe they're not right for you but you have Sally out there who you'd be great for.”
Jennifer Cohen · 56:30

#dating#friendship#spreadsheet#collaboration

Frameworks in this episode

Birth Control Mood Watch

Direct–Indirect Benefits Balance

Insights & moments

⚡Myth Buster· 2

Why Hormonal IUDs Are Not Merely Local