Around 65% of US women between the ages of 15 and 49 are on some form of contraception. About 17.5% of those women use the birth control pill. Most were first prescribed it as teenagers, often for reasons that had nothing to do with preventing pregnancy. Things like acne, painful periods, and irregular cycles. On the surface, it seems to work. Women on the pill dramatically reduce the chance of pregnancy and often see improvements in non-pregnancy issues for which they get a prescription. But below the surface, a decade or more of the pill does things to a woman's body that the average doctor doesn't discuss. If you are a man reading this, you have a stake in this too. The women in your life, the relationships you're in, the children you may have someday… All of it is downstream of a decision most women made before they were old enough to vote. Later in the piece, I go into what the male side of this equation looks like. Now, hormonal birth control can be legitimate medicine for some women with legitimate medical conditions. And if you take it electively, it’s your choice. No shame. I simply want you to know the potential drawbacks so you’re more confident talking with your doctor about these things and making the best decision for you. Here is what the research shows: Depression. In 2016, a Danish research team led by Charlotte Skovlund published a nationwide cohort study in JAMA Psychiatry following 1,061,997 women aged 15 to 34 for over six years. Combined oral contraceptives users had a 23% higher rate of first-time antidepressant use than nonusers. Adolescent users on combined oral contraceptives had nearly double the rate. All hormonal contraception types (pill, patch, ring, IUD) showed elevated risk, with the highest signals among the youngest women. Suicide risk. The same team published a 2018 follow-up in the American Journal of Psychiatry using a separate cohort of 475,802 Danish women. Current or recent hormonal contraceptive users had roughly double the risk of a first suicide attempt and triple the risk of completed suicide compared to women who had never used it. The highest risk was in the first months after starting. The patch showed the strongest signal, followed by the IUD, the ring, and the pill.