Discover more from Hold That Thought by Sarah Haider
Reduced to Ourselves
A book review (kinda) of This is Your Brain on Birth Control by Sarah Hill
Despite the long preamble about gender, my intention with this post was actually to write a book review of Sarah Hill’s This is Your Brain on Birth Control: The Surprising Science of Women, Hormones, and the Law of Unintended Consequences. But my interest in the book wasn’t all that medical (I am not currently on the pill, nor do I plan to be), but metaphysical: What is the authentic “self”? Does it matter? This is obviously pertinent when it comes to gender, which is where I begin.
There are many problems with gender ideology, but I think the one that confounds me most might be the obvious contradiction between “I want to be seen as I really am”—the idea that gender transition is necessary to live more authentically—and the actual process of it all. If gender transition was a social phenomenon, nothing more, then that would be one thing. However, gender transition includes:
drugs to block the production of the body’s natural hormones
synthetic hormones that mimic those of the opposite sex
a variety of surgeries to remove natural body parts or organs and surgically crafting others
Even if the process was merely physical—just mimicking the appearance of the opposite sex—that would be strange enough. The same argument with any other kind of cosmetic surgery (“I want to be seen as the skinny person I really am”) would be absurd on its face. Clearly, if you really were skinny, you wouldn’t need the surgery. Still, we accept gender transition on the grounds that there is an “inner self” which may be more aligned with one sex or the other, and that the cosmetic changes will ease the distress caused by the mismatch.
But in order to believe all this, we must be completely in denial about the role of hormones in making us who we are. When a person suppresses one’s natural hormones and instead infuses the body with synthetic hormones to match the hormonal profile of the opposite sex, that person is fundamentally changing not just their appearance, but their personality—who they are.
Interestingly, the personality changes from hormones are commonly known and accepted within the trans community, but rarely stated as such. Changes in mood, sex drive, even cognitive abilities are seen as mere “side effects”. Some trans people even report changes in sexual orientation, and are not alarmed by what this might mean. Of course the extent of the changes varies from individual to individual, still the fact of the matter remains: When you medically transition, you do not become “the authentic you”, you become a different you.
Whether that is positive or negative might depend on a lot of things—humans have always been deliberately modifying our “selves” in the small ways available to us. When I drink my cup of morning coffee, for example, I am “changing” into some other version of myself. Meanwhile, a wide variety of pharmaceuticals are increasingly ingested by Westerners—some to regulate our mood, others our sex drive, still others to increase our focus.
But for the most part, we intellectualize these drugs very differently—they are not making us “more like ourselves”, but rather, changing our natural state into one we find more convenient, desirable, or healthy. Gender transition is ultimately doing the same thing, despite the incoherent claims of internal authenticity.
But transitioners are not the only group to modify their natural biological functions and craft some other “self” through the use of synthetic hormones: Women who take hormonal birth control have been doing something similar, for decades, without knowing it. (I’m sure to lose some feminists with that comparison, but to those of you still here, bear with me girls. The comparison is with the medical aspects of hormonal birth control, not contraception in general.) Women’s experiences with the pill can help us understand the stakes in the much more extreme context of transition.
So without further ado, the promised review.
Who are we, anyway?
I never thought much of hormonal birth control, when I first used it. Scientists had found the ovulation switch, I presumed, and I was just turning mine off for a little while. I remember reading the little folded up sheet in the package listing the possible side effects, even getting excited about some of them. (Lighter periods! Less acne!) But I never got to those good parts, as I was immediately hurled into the bad parts, the worst of which were notably absent on my little sheet.
At that time, I had never taken any kind of recreational drug, or even had more than a few sips of alcohol, so I had no vocabulary to describe how the pill made me feel. Now, I compare it to being every-so-slightly high…an altered state in which everything seems indescribably “off”. It was reality, but somehow not the reality I was used to. I was me, but somehow not the me I had always been. This mild Alice in Wonderland sensation would have been merely intriguing, maybe even a little fun, if it wasn’t coupled with a brain fog no amount of coffee could shake. I felt like my brain had a cold, except I was not in any pain. My friend said I seemed even more dour than usual. I no longer felt “good” at writing.
No provider warned me about this. No health website I could find at the time reported on it. I found resonance only on Reddit forums where other women shared similar problems on the pill.
This is why it is so refreshing to read Sarah Hill’s book This is Your Brain on Birth Control.
This was my first exposure to a work about the pill that wasn’t centered largely around “rights”—whether or not women should have access, and who should pay for it. Hill does not have a political agenda—she is happy that women have control over their reproductive cycle (as am I, it should go without saying). Instead, her book was written to plug a hole in public knowledge: we should know what we are signing up for.
She begins by an overview of the general function of our hormones, how they make women women, and men men. From biological realities to reproductive strategies, Hill provides the reader with just enough background knowledge to help us grasp the context in which the pill is introduced, before going into what we know about how it works, and how it may alter our bodies and minds. She ends by theorizing about the bigger picture—the ways in which widespread use of the pill may have societal-wide effects.
Some tidbits from the book I found fun and surprising:
The lining of the uterus (endometrium) is not a baby-friendly wonderland, it is perhaps the opposite: a “downright inhospitable” environment for an embryo. “Rather than shepherding the egg through the implantation process, [the endometrium]’s densely packed cells make it more challenging for the fertilized egg to tap into mom’s blood supply there than almost anywhere else in the body”, says Hill. Scientists know this because evidently they have experimented with implanting embryos of mice on other parts of the body—and much to their surprise, those embryos flourished, “borrowing their way through tissues…destroying everything in their wake”. The mother’s body is a testing-ground, forcing the fertilized egg to face a series of challenges to prove that it is worth the investment of a costly pregnancy.
The pill is bad news for alpha males, but maybe a good deal for the soyboys, on the whole. Women on the pill seem not to notice cues of masculinity as well as naturally cycling women, and therefore make more “sensible” choices when settling down. For example: “When compared with naturally cycling women, pill-taking women exhibit less activity in the reward centers of the brain when looking at masculine faces, but more activity in these centers when looking at money.” Pill taking women are also “more satisfied with their partners’ financial-provisioning ability and intelligence than were the women who chose their partners when they were off it”.
Speaking of partners, it seems like shifting from one state to the other (going on or off the pill) after finding your partner is a bad idea. If you found your husband while on the pill, you might find him less sexy (even, repulsive) when you get off of it. But if you chose your husband off the pill, you will no longer appreciate the manly charms that helped drive you to him, making him a less appealing partner overall. There is only one scenario in which a change in birth control might make a woman more happy with her partner: the woman is on the pill, and although she cannot detect masculinity cues very well (and/or does not highly value them), she nevertheless stumbles on a macho partner who fulfills her other needs. This woman will have a sexy surprise waiting for her when she goes off hormonal birth control.
Many versions of the pill may have masculinizing effects on women, and one kind, somewhat anti-masculinizing. In other words, find the right one as may make your acne worse (or better), increase your shape-rotation abilities (or worsen them).
Medical research is rarely conducted on women, and the patriarchy may not be (entirely) to blame. Turns out we are just very tricky to work with–one must account for our cycles, and so researchers have to track that along with everything else. This can mean that a study can take several times as long to conduct, and cost a lot more besides. Even research conducted on rats tends to include only male rats. (Many women I know feel gaslit at the doctor’s, and this may be one of the reasons why.)
There was also a lot I didn’t exactly find surprising, but was interesting to read about in any case. I’ve heard of the way the pill can lower female sex drive, change our response to stress, make us less attractive to men, even lower enjoyment of music in other places. But I enjoyed reading about them in detail anyway—and although I will retain very little of the precise medical knowledge Hill shares, it laid a strong foundation for her main point, one that will stay with me:
Although hormonal birth control was created for a specific purpose, its function in the body is far more broad than that. As so much of “who we are” relies on our hormones, when the pill changes them, it necessarily changes us.
The one negative about the book (well, one of the two: Hill has kind of a corny sense of humor) is perhaps the endless throat-clearing Hill engages in throughout. She insists, time and time again, that regardless of any negative cost to the pill, she does not believe that women should never be on it, or that it is the wrong choice for all women, or that there should be limitations on access. She repeats that her goal is to allow women to understand the role the pill plays in creating who we are, so that women can better choose the “self” they want to be.
I recognize the pressure she must have felt (by colleagues, by editors, by loved ones) to include this caveat repeatedly. I just wish we didn’t live in a climate where it had to be done. It is, of course, annoying to read, but I think it is also a form of intellectual corruption. Think about it outside of this context: what if this book was about alcohol or tobacco? Wouldn’t it be strange for any scientist writing about it to first declare allegiance to a political position—to make clear right from the outset, that they are never going to be in favor of any restriction? Shouldn’t the latter depend, quite a bit if not entirely, on what the nature of the findings are? If Sarah Hill found, for example, that the pill bore a far greater harm than was previously known, that we are riddling our girls with cancer or something else extreme? Wouldn’t she allow this knowledge to affect her position on legislation?
If she is as reasonable as she comes across in the book, the answer is: of course she would. But in order to get an audience with the women who need to hear this, I think she felt that she had to put the cart before the horse. Which says little about her, but a lot about the distorted nature of how we think about important issues: We first choose where we want to go, set the course to the destination, and only then open our eyes to see the terrain lying before us.
There is a way in which her confident assertions about the value of “choosing” who we want to be both reassure and irk me. Sure, choice is often good: what we understand as “progress” is inherently centered on overcoming various limitations. First those limits were environmental, and we began to conquer our natural world. Then, those limits became social, and we began to form a more just, tolerant society. Now, progress has turned its gaze inward: how do we surpass our bodies? This latter project is sure to lead to some wonders (ending disease! re-creating limbs! slowing aging!), and will grant us “choices” we couldn’t have dreamed possible. But as I wrote in my recent post about surrogacy, freedoms are not entirely free, that with every gain, there is a corresponding loss. Sometimes that loss is a moral good too, but other times, it is more complicated.
In the case of altering our hormones, “complicated” doesn’t begin to cover it. We know what it means to gain more choice. Do we know what it means to lose ourselves?