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“Part road map for women looking for scientific explanations for their behavior, part geeky manual for relationship woes... Brizendine is at her best when describing the neurochemical underpinnings of pas- sionate love.” —San Francisco Chronicle

“A wonderful new book... Brizendine’s book shares how women’s brains and hormones cause us to value different things during differ- ent stages of our lives, which can affect everything from career deci- sions to who we fall in love with.” —Gannett News Service

“It’s bloody brilliant.... It’s answered not only the questions that have plagued me for years, but it’s answered questions I hadn’t even for- mulated yet. I am so not kidding.... I’m just glad to have a book that is not only fascinating, it makes me feel less insane.” —The Huffington Post

“Brizendine lays out the key stages of life in eight juicy chapters, solidly useful wherever you are on her timeline. I wish I’d been able to read ‘Why the Teen Girl Brain Freaks’ at puberty. Of course, knowledge is power.. .” —Bust magazine

“A trove of information, as well as some stunning insights... While this book will be of interest to anyone who wonders why men and women are so different, it will be particularly useful for women and parents of girls.” —Publishers Weekly

“This book should be required reading for all women, and it wouldn’t hurt for men to give it a glance as well.” —Pilot (North Carolina)

“Brizendine is onto something.... This is going to be a bumpy ride.” — William Booth, Washington Post

The Female B

B B N e w Y o r k

rain

r o a d w a y o o k s

Louann Brizendine, M.D.

For my husband, Samuel Barondes,

My son, John Whitney Brizendine,

And in loving memory of Louise Ann Brizendine

C o n t e n ts

APPENDIX ONE: The Female Brain and Hormone Therapy 165

APPENDIX TWO: The Female Brain and Postpartum Depression 181

APPENDIX THREE: The Female Brain and Sexual Orientation 185

NOTES 189

REFERENCES 211

INDEX 271

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A C K N O W L E D G M E N T S

This book had its beginnings during my educational years at the University of California, Berkeley; Yale; Harvard; and University Col- lege, London, so I would like to thank the teachers and fellow students who most influenced my thinking during those years: Frank Beach, Mina Bissel, Henry Black, Bill Bynum, Dennis Charney, Marion Dia- mond, Marilyn Farquar, Carol Gilligan, Paul Greengard, Tom Guteil, Les Havens, Florence Haseltine, Marjorie Hayes, Peter Hornick, Stan- ley Jackson, Valerie Jacoby, Kathleen Kells, Kathy Kelly, Adrienne Larkin, Howard Levitin, Mel Lewis, Charlotte McKenzie, David Mann, Daniel Mazia, William Meissner, Jonathan Muller, Fred Naftolin, George Palade, Roy Porter, Sherry Ryan, Carl Salzman, Leon Shapiro, Rick Shelton, Gunter Stent, Frank Thomas, Janet Thompson, George Vaillant, Roger Wallace, Clyde Willson, Fred Wilt, and Richard Woll- heim. During my years on the faculty at Harvard and the University of California, San Francisco, my thinking has been influenced by Bruce Ames, Cori Bargmann, Regina Casper, Francis Crick, Mary Dallman, Herb Goldings, Deborah Grady, Joel Kramer, Fernand Labrie, Jeanne Leventhal, Sindy Mellon, Michael Merzenich, Joseph Morales, Eu- gene Roberts, Laurel Samuels, Carla Shatz, Stephen Stahl, Elaine Storm, Marc Tessier-Lavigne, Rebecca Turner, Victor Viau, Owen Wolkowitz, and Chuck Yingling. My colleagues, staff, residents, medical students, and patients in the Women’s and Teen Girls’ Mood and Hormone Clinic have contributed in many ways to this work: Denise Albert, Raya Almufti, Amy Berlin,

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A c k n ow l e d g m e n ts

Baron-Cohen, Jill Becker, Andreas Bartels, Lucy Brown, David Buss, Larry Cahill, Anne Campbell, Sue Carter, Lee Cohen, Susan Davis, Helen Fisher, Jay Giedd, Jill Goldstein, Mel Grumbach, Andy Guay, Melissa Hines, Nancy Hopkins, Sarah Hrdy, Tom Insel, Bob Jaffe, Martha McClintock, Erin McClure, Eleanor Maccoby, Bruce McEwen, Michael Meaney, Barbara Parry, Don Pfaff, Cathy Roca, David Rubi- now, Robert Sapolsky, Peter Schmidt, Nirao Shah, Barbara Sherwin, Elizabeth Spelke, Shelley Taylor, Kristin Uvnäs-Moberg, Sandra Wi- telson, Sam Yen, Kimberly Yonkers, and Elizabeth Young. I also thank supporters with whom I have had lively and influential conversations over the past few years about the female brain: Bruce Ames, Giovanna Ames, Elizabeth Barondes, Jessica Barondes, Lynne Krilich Benioff, Marc Benioff, ReVeta Bowers, Larry Ellison, Melanie Craft Ellison, Cathy Fink, Steve Fink, Milton Friedman, Hope Frye, Donna Furth, Alan Goldberg, Andy Grove, Eva Grove, Anne Hoops, Jerry Jampolsky, Laurene Powell Jobs, Tom Kornberg, Josh Leder- berg, Marguerite Lederberg, Deborah Leff, Sharon Agopian Melodia, Shannon O’Rourke, Judy Rapoport, Jeanne Robertson, Sandy Robert- son, Joan Ryan, Dagmar Searle, John Searle, Garen Staglin, Shari Staglin, Millicent Tomkins, Jim Watson, Meredith White, Barbara Willenborg, Marilyn Yalom, and Jody Kornberg Yeary. I would also like to thank the individuals and private foundations that have supported my work: Lynne and Marc Benioff, Larry Elli- son, the Lawrence Ellison Medical Foundation, National Center for Excellence in Women’s Health at UCSF, the Osher Foundation, the Salesforce.com Foundation, the Staglin Family Music Festival for Mental Health, the Stanley Foundation, and the UCSF Department of Psychiatry. This book was initially developed through the skill and talent of Susan Wels, who helped me write the first draft and organize vast amounts of material. I owe her the greatest debt of gratitude. I am very thankful to Liz Perle, who first persuaded me to write this book, and to the others who believed in it and worked hard to make

xi

A c k n ow l e d g m e n ts

it happen: Susan Brown, Rachel Lehmann-Haupt, Deborah Chiel, Marc Haeringer, and Rachel Rokicki. My agent, Lisa Queen of Queen Literary, has been a terrific supporter and has made many brilliant suggestions throughout this process. I am especially grateful to Amy Hertz, vice president and publisher of Morgan Road Books, who had a vision for this project from the be- ginning and kept demanding excellence and crafting revisions to cre- ate a narrative in which the science comes alive. I also want to thank my son, Whitney, who tolerated this long and demanding project with grace and made important contributions to the teen chapter. Most of all I thank my husband and soul mate, Sam Barondes, for his wisdom, endless patience, editorial advice, scientific insight, love, and support.

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T H E C A S T O F N E U R O - H O R M O N E C H A R A C T E R S

(in other words, how hormones affect a woman’s brain)

T he ones your doctor knows about

Estrogen —the queen: powerful, in control, all-consuming; some-

times all business, sometimes an aggressive seductress; friend of dopamine, serotonin, oxytocin, acetylcholine, and norepinephrine (the feel-good brain chemicals).

Progesterone —in the background but a powerful sister to es-

trogen; intermittently appears and sometimes is a storm cloud re- versing the effects of estrogen; other times is a mellowing agent; mother of allopregnenolone (the brain’s Valium, i.e., chill pill).

Testosterone —fast, assertive, focused, all-consuming, mascu-

line; forceful seducer; aggressive, unfeeling; has no time for cud- dling.

T he ones your doctor may not know about that also affect a woman’s brain

Oxytocin —fluffy, purring kitty; cuddly, nurturing, earth mother;

the good witch Glinda in The Wizard of Oz; finds pleasure in help- ing and serving; sister to vasopressin (the male socializing hor- mone), sister to estrogen, friend of dopamine (another feel-good brain chemical).

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P H A S E S O F A F E M A L E ’ S L I F E

Hormones can determine what the brain is interested in doing. They help guide nurturing, social, sexual, and aggressive behaviors. They can affect being talkative, being flirtatious, giving or attending parties, writing thank-you notes, planning children’s play dates, cud- dling, grooming, worrying about hurting the feelings of others, being competitive, masturbating and initiating sex.

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Phases of a Fema l e ’ s L i f e

Major Hormone W Females H Changes T Males Don’t F

G

P

S

P

Breast feeding

Child rearing

P

M

P

testosterone increase and

Oxytocin, prolactin

testosterone

testosterone

female-specific circuits

choosing a career or job

petition

More calmness

hat ave hat etal

irlhood

uberty

exual maturity, single woman

regnancy

erimenopause

enopause

ostmenopause

Brain growth and develop- ment left unperturbed by the high testosterone that makes a male brain

Estrogen is secreted in mas- sive amounts from age 1 to 24 months, then the juvenile pause turns off hormones Estrogen, progesterone, and begin to cycle monthly

Estrogen, progesterone, and testosterone change every day of the month

Huge increases in proges- terone, estrogen

Oxytocin; cycling estro- gen, progesterone, and

Erratically cycling estro- gen, progesterone, and

Low estrogen and no progesterone; high FSH/LH

Low, steady estrogen and testosterone; lower oxytocin

Brain cells are XX, which means more genes for faster brain development and

High estrogen for up to 2 years after birth

More estrogen and less testosterone; girls’ brains develop 2 years earlier than boys’ More focus on relationships, finding a lifelong mate, and compatible with raising a family Focus more on nesting, how the family will be provided for; less on career and com-

Focus more exclusively on the baby

Less interest in sex, more worry about kids

Fluctuating interest in sex, erratic sleep, more fatigue, worry, moods, hot flashes, and irritability The last precipitous brain change caused by hormones

xviii