A mind of her own
New book by Sausalito author answers the age-old question—what the heck is she thinking?

BY JILL KRAMER

So what’s a nice feminist like Dr. Louann Brizendine doing in a politically incorrect controversy like this? Brizendine earned her feminist credentials with the best of them—from her freshman year at UC Berkeley in 1971 working in the Women’s Herstory Library to her more recent days challenging the university hierarchy as well as conventional wisdom by establishing the Women’s Mood and Hormone Clinic at UCSF’s Langley Porter Hospital. Now she’s taking flak for writing a book that flies in the face of feminist fundamentalism: The Female Brain.

Yes, she writes, men’s and women’s brains are different.

Different, however, doesn’t mean that either one is superior, she cautions. And in the next breath she’ll acknowledge that women are basically better suited for world leadership since they’re more inclined to negotiation and less inclined to warmongering. In fact, much of her book is raising more hackles among men than women. It’s most threatening to the testosterone set because it’s science-based.

Before Brizendine went to Yale Medical School, she earned an undergraduate degree in neurobiology at Berkeley, where her professors were among the first to publish papers on how the brain is shaped by hormones, starting in the eighth week in the womb. She did her residency in psychiatry at Harvard, then joined the Harvard faculty for three years before taking a job at Langley Porter in 1988. She founded the Women’s Mood and Hormone Clinic in 1994, one of the first clinics of its kind. Today her work remains on the cutting-edge of the field. She was prompted to write her book because nothing like it existed and her patients were tired of waiting for someone else to do it. Apparently the rest of the world has been waiting, too. She now has to make room in her busy schedule to grant interviews to major media outlets. She’ll appear on ABC-TV’s 20/20 September 29 at 10pm.

Brizendine (rhymes with “spine”) lost her home in the 1991 Oakland Hills fire and her first marriage went up in flames shortly after. Her son was 2 at the time and she spent the next few years as a single mom. Since ’96 she’s been living in Sausalito with the “love of her life,” Dr. Sam Barondes. The director of the UCSF Center for Neurobiology and Psychiatry, he works on the floor above her office at Langley Porter.

Brizendine, 53, is small and fine-boned, with a delicately sculpted nose and a square jaw. She wears her auburn hair pulled back in a ponytail with long bangs she occasionally brushes off her forehead with a tiny hand. She enunciates with exquisite care, as if she were biting off each word and tasting it. She sips out of a can of Diet Sunkist soda. When I ask her to talk about hormones and marital infidelity, she grabs the can and throws back the last of the soda, as if she were bracing herself with something considerably stronger.

• • • •

Let’s talk about marital infidelity.
[setting down the now-emptied soda can] That part of my book is bothering a few men. They’re very upset by that.

There were a couple of very surprising things. One was that 10 percent of fathers are not biologically related to the children they believe are theirs.
Scientists who do human genetic research—which is usually the tracking of some disease, like cystic fibrosis or Huntington’s disease—they’re looking at family histories and their genes going back three generations, so they can know with certainty whether this person’s DNA matches the father’s. And we call it the “dirty little secret” of genetic research, that they have to throw out roughly 10 percent of their data in these studies because the DNA does not match. What they say is, “The paternity factor didn’t work out.” Obviously, the researchers are not allowed to say anything about that to the family, they just quietly drop that particular individual from the study. And people get dropped for a whole lot of reasons [laughing], so if you’ve been dropped from a study, don’t think they’ve necessarily found out your father isn’t your father!

In the book you say that natural gene selection will drive a woman in her reproductive years to cheat on her husband because she’s looking for the best genes for her offspring.
The theory of evolutionary psychologists is that there’s a drive in all of us to have our gene pool go forward. And women don’t even think about it, but we may just be hard-wired to do this. It’s most often those two to four days before her ovulation—which is the most likely time to get pregnant—that she is most interested in flirting or being sexual outside of a monogamous relationship. That’s when a woman’s testosterone level is highest. But this is a tough topic to even broach with most heterosexual males.

And there’s a genetic connection to monogamy in men.
We know some of the genes that lead to monogamy in mammals and we’ve looked at these genes in the human male. But the correlation between those genes and whether that male is actually monogamous hasn’t yet been studied. Vasopressin in the male brain and oxytocin in the female brain both have to do with social and mating relationships and parenting and bonding. And many of those studies have just begun to be looked at in humans. I’m not sure anyone would want to fund that study. Only a female funding source would want to [laughing].

OK, but if we were to accept this hypothesis, theoretically you could say that if your husband’s father was monogamous, your husband will be, too. And if his dad fooled around, you might have a problem.
The fidelity or infidelity of a man’s father would give you some indication of two things: one, what genetic pool that man comes from and also what was acceptable and not acceptable in terms of behavior. So the monogamous man probably has a genetic propensity for monogamy and, behaviorally, that was the message to his son, that that’s how you behave as a man. And that becomes part of your brain circuitry. The experience you have with your same-sex parent in your growing-up years is very important.

So your brain can actually change depending on what you observe.
I think so, yes. And I think that’s a very hopeful message. One of the things I teach people is that the nature/nurture question is dead—because every little experience you have changes your brain cells. So the “nurture” experience, the environment, has a dialogue with your brain circuits, your “nature.” What you’re born into this world with gives you certain propensities, but the environment actually changes the brain. That’s why, as a society, we need to be heavily involved with our young people. If you’ve got a kid who comes from some horrible environment, and you can get him into a better, more enriched environment where he is being mentored better, you have the chance to change his brain circuits for life! That’s a huge, hopeful message.

Another surprising thing in the book was that 65 percent of divorces in people over 50 are initiated by the wives, not the husbands.
It’s the opposite of the mythology—which is that the man’s in his 50s, he’s tired of his old wife and he runs off with his 25-year-old secretary. And of course that does happen. But maybe the reason he runs off with the secretary is because his wife has had it with him! She could care less. She has tended the needs of the children, tended the needs of the husband, done all of the things dictated by a woman’s hormone circuitry. But once the children are out of the nest and the estrogen that runs the female circuits is at a low ebb, all of a sudden she wants a partner who enhances her life. And if her husband can do that, then fine. But if not, she may just decide she wants to go on and do some things of her own. We know that when estrogen drops, oxytocin drops as well. So the hypothesis is that the postmenopausal female’s brain is freed from the drive to tend to the needs of others, freed to tend to her own needs.

I was interested to read that a woman is most likely to get pregnant if she has an orgasm in the period one minute before the man’s ejaculation and 45 minutes after!
Yes, there’s an upsucking of the sperm with her orgasm.

So the message to husbands trying to impregnate their wives is, keep at it!
Right—whatever it takes to get her to have an orgasm while there’s sperm in her canal, do it, buddy! Don’t go to sleep afterwards—get busy!

Do doctors tell couples that when they’re trying to get pregnant?
Never. The other thing is that a woman may be more likely to have orgasms with her hot lover on the side, right before ovulation, which means she’s more likely to get pregnant by him—and there’s your 10 percent!

The crux of your book has to do with the differences between the male and the female brain. Talk about how hormones shape the brain in the womb.
We know now that the female brain is the beginning of all brains, up to eight weeks. And at eight weeks, the tiny testicles of a male fetus start pumping out huge amounts of adult-level male testosterone, which marinates those brain cells. And that stimulates the growth of certain cells and circuits in the brain that have to do with sexual pursuit behavior. It also acts as a sort of weed-killer in other brain areas that haven’t all been worked out yet. But the female brain is left to continue to progress, unperturbed by testosterone.

So how do those hormone differences play out?
Aggression and sexual pursuit behavior are the two big things that are very, very different about the male brain versus the female brain. Those circuits and those propensities are already formed at birth. And they’re reinforced all during life. And obviously, civilization educates the young to not do bad, aggressive things to hurt other people. So even though their brains are programmed to haul off and slug somebody, we teach little boys not to do that.

And how does that compare with girls’ behavior?
The kind of play behavior you get with girls is, they’ll be sitting there and one will say, “Why don’t you be the mommy and I’ll be the daddy?” They assign roles that have relationship interaction. “I’ll be the doctor and you be the patient.” Boys will imagine themselves as a superhero who’s conquering some enemy. And I often get asked, “Dr. Brizendine, does that mean that women would be better at being world leaders? Don’t they have more of a propensity to negotiate settlements rather than to wage aggressive wars?” And I’ll say, yes, the female brain is more inclined to negotiate and doing battle is just not part of their fantasy world.

These days we’re seeing a lot of female superheroes, too.
Any time you talk about gender differences, you’ve got to remember there are overlap areas in everything you look at. So 10 percent of boys will play in some ways or be interested in some things in the girl category and 10 percent of females will be interested in boy things. There are going to be mixes and matches in all kinds of things. But I think it’s important to honor the differences that we’re born with and how we’re basically shaped and to not blame each other for how we are. That doesn’t mean we shouldn’t try to think about how we want both genders to be able to maximize their personal best and their creative talents, and to be civilized human beings who live peacefully together.

I imagine there must be variations in the amount of hormones that fetuses are exposed to in utero, and that must influence their behavior later.
Right. And although there’s no supply of testosterone with the female fetus, she’ll get a little from the metabolism of hormones, and one girl may get slightly more than another. Or if it’s a boy-girl twin set, the girl will get a little testosterone that leaks over to her from the boy. And a little bit of testosterone goes a long way during the developmental phase of the fetus. Even mothers being under more stress during pregnancy will have an effect. If she’s carrying a boy fetus, it tends to de-masculinize him by blocking some of the effects of testosterone. In the female fetus, it seems to increase the masculinizing effects. These are all animal studies and there’s a big leap to humans. So that work has yet to be done.

Tell me about your early years.
When I was born, my parents were living in Appalachia, in Hazard, Kentucky. We were barely above the poverty line. They were there as missionaries. My father was the minister of the Christian church there while he was getting his theological degree in Lexington. He would visit people living in trailers, doing compassionate church work, getting clothes for their children, just the basics. And my mom taught kindergarten for 40 years. And they were very involved in the civil rights movement with Martin Luther King. We were very often the only white family in Southern black churches and my father would deliver a sermon as the guest preacher. He was a very charismatic, gifted speaker. So I was in that world first and then we moved to Southern California where my parents worked with [migrant labor leader] Cesar Chavez. They believed that you should make a difference in society in promoting people’s human rights and civil rights. They were also very involved in the personal growth and humanistic movement with Fritz Perls and Carl Rogers. My son now asks me, “Mom, were you a hippie?”

Were you?
Well, sort of. I was at UC Berkeley starting in 1971, right at the very height of the feminist movement. My first work/study job was working in the Women’s Herstory Library, which at the time was off the campus in the garage of the woman who started it. UC Berkeley was so exciting in those days. That’s where the youth movement was happening, that’s where the feminist movement was happening, that’s where the new world was being created. That was where we kids were having our say. My freshman year, I walked to my classes through tear gas. And I guess that’s one of the reasons I’ve been able to do this work with the Women’s Hormone Clinic—much to the chagrin, probably, of the establishment hierarchy at the university, which does not necessarily encourage being too far ahead of the curve, or being outspoken. But I’m just passionate about what I’ve been doing. And when I come up against a roadblock I figure out a way to go around it, or to encourage the block to move. I have a vision and I am moving towards it. And that’s partly because I was born that way, but your personality is also shaped by your experience with your family.

Well, clearly your parents imbued you with the idea that you could do anything, that you weren’t limited by being female.
There were a lot of very strong female role models in my family. I didn’t play with dolls in the way that other girls do. I loved dolls because I could make clothes for them. I sewed all of their clothes. And when I was in medical school, one of the things I liked was ear, nose and throat surgery. I was very good with my hands and making those tiny little stitches you have to do with a microscope. But I hated the life of a surgeon, and the mentality of surgeons. It was not very creative. It was sort of boring. And very much a man’s world. When I went to Yale Medical School, all of the surgeons were men.

Tell me about your years on the faculty at Harvard.
Harvard is not very nice to women faculty and they’re really nasty to junior professors. So being a female junior professor meant that I was treated doubly nasty. There’s a 400-year-old Old Boy network there, where you can move up through the ranks pretty quickly if you’ve got the right male mentor. And it’s like that here, too, but there are a lot more women in positions of power here now and it’s always been more female-friendly at UCSF—but on a scale of one to 10, Harvard is a one and UCSF is a three. So it’s all relative. Anyway, after three years as an instructor at Harvard I realized I was going nowhere fast. Harvard eats their young faculty.

You mention in your book that infamous remark [former Harvard president] Lawrence Summers made about women lacking ability in math and science. Of course, that was long after you were gone.
The 14th of January, 2004.

You remember the date?!
And he resigned 15 months after that fateful error. It was a friend of mine, Nancy Hopkins, who walked out of that meeting and called the Boston Globe.

I thought you went pretty easy on him in the book.
Well, he deserved everything he got, but the reality is that he’s not alone in this. He’s just one of many who should suffer the same fate [laughs].

So you joined the faculty at UCSF to advance your career.
Well, the job I took at UCSF was assistant medical director of the inpatient unit for depression at Langley Porter. Teaching was something I was assigned because nobody else wanted to do it. Someone said, “If you want to get promoted, you have to teach this course.” So I ran the program for teaching Psychiatry 101 to 150 medical students and 28 teachers were under me. I was writing a textbook for that when my house burned down in the Oakland Hills fire and several of my chapters went poof and that was the end of my first book.

How did you come to establish the Women’s Hormone Clinic?
After the fire, my marriage ended and I became a single mom with a 2-year-old son. So I decided I wanted to go into the outpatient department, which wasn’t as intense as inpatient. And I started supervising residents. They would bring their cases to me and we would discuss the treatment plan. I also had a private practice. This was around 1989 to ’90. And patients were coming to me complaining of decreased libido. And often they were taking medications like Prozac. And none of the clinical studies had bothered to ask the women if they were having sexual problems. They would ask the men, but they didn’t ask women if they had any change in their sexual function or their orgasm because sexual function for women is optional. Lack of erections or ejaculation are medical emergencies, right? So it wasn’t until a number of years later that the drug companies started adding those questions for women. Pfizer was the first one to do that, when they brought out Zoloft in ’92. Lilly did not do that for the clinical studies on Prozac. So I was seeing lots of women with depression who were on Prozac with decreased libido and there was nothing in the medical literature, so I said, why don’t we measure her hormones? I knew from my education at Berkeley that testosterone is what gives males and females their sex drive, so I measured these women’s levels of testosterone and found they were perimenopausal [in the stage leading up to menopause] and their testosterone levels were very low. And I started a weekly seminar here, “Hormones and Psychiatry,” in 1993. There were people from OB-GYN, from reproductive endocrinology, research people, psychiatric social workers, nursing staff, some of my residents would come. It was a multidisciplinary group and we would think together about patients we were seeing, looking at the whole woman: the sociology, the psychology, the growing-up years, the psychodynamics, the couples relationships. All of those things were taken into account, including the mood scales for depression and her hormones. And nobody in the country was doing that at the time. There was no body of literature that we could turn to. And out of that, the Women’s Mood and Hormone Clinic was born in 1994. The whole field is very, very new to this day.

From what you say in the book, it sounds like you are an advocate of hormone replacement therapy [HRT]. You’re basically saying, “After menopause, your brain is going to shrink, you’re going to lose cognitive ability, if you don’t take estrogen!” That’s scary!
Well, there are all kinds of studies hinting that this may indeed be the case and I think we need to think carefully about that. But so what if you’ve got healthy brain circuits if you’re dead from cancer!

Right!
So what’s needed is an individual assessment of what your relative risk and benefit is. And I think maybe one of the reasons the breast cancer rate in Marin was higher than other places is because there were more women taking HRT.

But even if you decide to take hormone replacement therapy, how long do you take it? As soon as you stop, your brain’s going to shrink anyway! You just take it until you retire?
There are no answers. And doctors feel like, “Oh, my God, we were recommending this to everyone—we were betrayed by the drug companies who have been pushing this forever and we’ve been doing our patients harm!” Which made doctors feel terrible! And at the same time, there are these studies that show that estrogen is like a tonic to the brain.

It’s a tightrope to walk.
Worse, it’s a razor’s edge. So what I do is take each individual woman and look at it on a year-by-year basis. No one in my clinic goes on any hormones if she has any major risk factors. We just don’t do that. But if she doesn’t have risk factors and she does have a lot of [menopausal] symptoms—if she’s feeling uncomfortable with her mood, hot flashes, whatever it is—we’ll try it for a few months, and if there’s enough benefit, we’ll carefully follow it.

What kind of feedback have you been getting about the book?
Every week I get e-mails which I treasure so much. This one woman wrote me saying, “Dr. Brizendine, my husband and I read your book together and it saved our marriage.”

I guess it helps people understand that the things they fight about don’t mean that they hate each other, it just means that their brains are working differently.
Bingo! This other woman said to me, “He finally understood why I need to talk about how I feel about something.” And the man said, “I used to think she just wasn’t being very efficient, that she had to dither around and talk about how she feels and it used to infuriate me. Now I know that’s just how her brain works and that’s what’s supposed to happen.” And another man said, “I used to think I must be heartless because I didn’t care as much about things as she did. And now I feel so much better—I realize I’m just different.”

It enables people to forgive themselves.
To me, honestly, this book is about forgiveness. The metamessage is about allowing people to own who they are, what feelings they have, what impulses they have. And males get to stop blaming females and females get to stop blaming males for being who they are.

PHOTO OF DR. LOUANN BRIZENDINE BY JAMES HALL

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