My reflections on “Birth Control Changes Who You Are”

I recently checked out the Diary of a CEO episode a titled “Women Health Expert: Birth Control Changes Who You Are & How You Feel About Your Partner” featuring Dr. Sarah Hill.  It’s part of an ongoing conversation about how hormonal contraception may do more than prevent pregnancy — specifically, it argues there can be shifts in mood, identity, sexual attraction, partner preference, and satisfaction, which can change when someone stops using the pill.  

As someone who treats both men and women of all ages with hormone therapies, I found this discussion both fascinating and deeply relevant. Here are some thoughts I want to share with you — the good, the challenging, and the clinical implications.

What the Emerging Evidence Suggests

From what the video/podcast summarizes:
    •    Hormonal birth control may subtly modulate partner attraction: some studies suggest that women who go off hormonal contraception report changes in how attractive they find their partner.  
    •    Mood, libido, sexual satisfaction, and relationship satisfaction may also shift when starting, stopping, or changing hormonal contraceptives.  
    •    There seem to be individual differences: how pronounced or meaningful these changes are depends on many factors (the type of hormones used, dosage, individual biology, psychological expectations, relationship context).  

Why It Resonates With HRT Practice

Because I work with people on various hormone regimens — not just contraceptives — a few themes from this discussion strike me as relevant in clinical care:
    1.    Identity & Self-perception
Hormones aren’t just about physical changes. They interact with mood, emotional regulation, senses of self, sexual desire, and interpersonal attachments. For many, being on or off a hormone can feel like shifting parts of their personality or self-expression. In HRT, we often expect physical change, but we also need to anticipate emotional and relational change.
    2.    Attraction and Relationships
If hormonal treatments or birth control can shift partner preferences or sexual attraction, then changes in therapy (or stopping it) might lead to relational tension or confusion. Clinically, it’s important to prepare patients: to normalize that these shifts can happen, that they may be subtle or temporary, and to provide support (including counseling or couples work) if needed.
    3.    Expectations & Communication
Some of the subjective effects may be mediated by expectations (what someone anticipates before going on/off therapy), the nocebo/placebo effects, and narrative. In hormonal contraception literature, expectation predicts experience of side effects.   For HRT, this means that how we frame the therapy—what patients believe it will do or not do—matters a lot.
    4.    Variation Across Age, Sex, Hormone Types
What holds for contraceptive estrogen/progesterone combinations in younger people may not directly translate to estrogen therapy for menopausal women. Different hormones, different dosing, different baseline biology. But the principle — that hormones can ripple beyond the endocrine system into psychology, attraction, interpersonal dynamics — seems generalizable.

Clinical Implications & Guidance

Here are some “take-home” ideas from a clinician’s lens, that might help us and our patients navigate this complexity:
    •    Pre-treatment conversations: When prescribing hormones or making changes, it’s worth discussing possible effects on mood, libido, attraction, relationships. Not everyone will notice anything, but setting expectations helps.
    •    Regular check-ins: Revisit how someone feels emotionally and relationally after starting or stopping a hormone. If someone describes feeling “different” in ways that matter to their identity or relationship satisfaction, validate that this can be part of the hormonal effect.
    •    Holistic assessment: Include mental health, relational satisfaction, partner dynamics, sexual satisfaction in follow-ups, not just physical side effects. If someone is distressed, consider referrals to psychosexual counseling or other support.
    •    Flexibility: Be willing to adjust hormone type, dose, or schedule to mitigate unwanted relational/mood/attraction shifts. Sometimes small changes (different formularies, different delivery systems) can affect outcomes.
    •    Patient agency: Empowering patients — letting them know they can try going off a given method (if medically safe), or switching types, to see whether certain feelings change. And helping them interpret whether changes are transient or more lasting.

Reflections & Questions Moving Forward

Finally, a few reflections & open questions I’m mulling over (and I think about these with my patients too):
    •    How much of perceived personality change is hormonal vs psychological/relational vs societal expectation?
    •    How long do shifts in attraction or identity last after stopping hormones? Is there a “re-settling” period, and how predictable is it?
    •    To what extent do these findings apply to all people on HRT?
    •    How do comorbidities (mental health history, relationship stress, life stage) moderate these effects?

Conclusion

This conversation is important — not just as intellectual curiosity, but as something that has real effects in people’s lives. As clinicians treating people with hormones, it’s part of our responsibility to see both the hormonal and relational dimensions of treatment. Hormones can shift things subtly but meaningfully: how one feels, how one relates, how one perceives their partner, their self.

If nothing else, this video/podcast reinforces that “the hormone prescription” isn’t a purely physical intervention. It reaches deep into mood, desire, identity, attraction, and relational life. And so our care benefits when patients are informed, listened to, and supported across all those dimensions.