Endocrine Disruption of Androgenic Activity by Perfluoroalkyl Substances: Clinical and Experimental Evidence

J Clin Endocrinol Metab. 2019 Apr 1;104(4):1259-1271. doi: 10.1210/jc.2018-01855.


Background: Considerable attention has been paid to perfluoroalkyl compounds (PFCs) because of their worldwide presence in humans, wildlife, and environment. A wide variety of toxicological effects is well supported in animals, including testicular toxicity and male infertility. For these reasons, the understanding of epidemiological associations and of the molecular mechanisms involved in the endocrine-disrupting properties of PFCs on human reproductive health is a major concern.

Objective: To investigate the relationship between PFC exposure and male reproductive health.

Design: This study was performed within a screening protocol to evaluate male reproductive health in high schools.

Patients: This is a cross-sectional study on 212 exposed males from the Veneto region, one of the four areas worldwide heavily polluted with PFCs, and 171 nonexposed controls.

Main outcome measures: Anthropometrics, seminal parameters, and sex hormones were measured in young males from exposed areas compared with age-matched controls. We also performed biochemical studies in established experimental models.

Results: We found that increased levels of PFCs in plasma and seminal fluid positively correlate with circulating testosterone (T) and with a reduction of semen quality, testicular volume, penile length, and anogenital distance. Experimental evidence points toward an antagonistic action of perfluorooctanoic acid on the binding of T to androgen receptor (AR) in a gene reporter assay, a competition assay on an AR-coated surface plasmon resonance chip, and an AR nuclear translocation assay.

Discussion: This study documents that PFCs have a substantial impact on human health as they interfere with hormonal pathways, potentially leading to male infertility.

MeSH terms

  • Adolescent
  • Caprylates / analysis
  • Caprylates / toxicity*
  • Cross-Sectional Studies
  • Endocrine Disruptors / analysis
  • Endocrine Disruptors / toxicity*
  • Environmental Pollutants / analysis
  • Environmental Pollutants / toxicity*
  • Fluorocarbons / analysis
  • Fluorocarbons / toxicity*
  • HeLa Cells
  • Humans
  • Infertility, Male / chemically induced
  • Infertility, Male / diagnosis
  • Italy
  • Male
  • Organ Size / drug effects
  • Penis / anatomy & histology
  • Penis / drug effects
  • Receptors, Androgen / metabolism
  • Reproductive Health*
  • Semen / chemistry
  • Semen / drug effects
  • Semen Analysis
  • Testis / anatomy & histology
  • Testis / drug effects
  • Testosterone / blood
  • Testosterone / metabolism*
  • Young Adult


  • AR protein, human
  • Caprylates
  • Endocrine Disruptors
  • Environmental Pollutants
  • Fluorocarbons
  • Receptors, Androgen
  • Testosterone
  • perfluorooctanoic acid