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1. Sarah Janssen, M.D., Ph.D., M.P.H.
Science Fellow, Natural Resources Defense Council
sjanssen@nrdc.org
Hormonal Effects of
Chemical Pollutants –
Endocrine Disruptors and
Reproductive Health

2. Increasing Incidence of Health
Conditions
• Infertility
• Premature births
• Birth defects of genitalia
• Early onset of puberty
• Cancer - testicular
• Neurological conditions – ADHD, autism
• Insulin resistance/Diabetes
• Obesity

3. Endocrine Disruptor
• “An exogenous agent that interferes with
the synthesis, secretion, transport,
binding, action, or elimination of natural
hormones in the body that are responsible
for the maintenance of homeostasis,
reproduction, development, and /or
behavior.”
U.S. EPA, February 1997
• Or in simpler terms:
“A substance which interferes with natural
hormones.”

5. Endocrine disruptors and health
• Abnormal development of reproductive
organs or neurological system
• Reduced fertility – male and female
• Poor birth outcomes – LBW/IUGR, SA
• Development of pre-cancerous/cancerous
lesions
• Lower IQ
• Behavioral abnormalities

6. Synthetic Estrogens
• Seven women ages 15-
22 presented at the
Massachusetts General
Hospital with clear cell
adenocarcinoma of the
vagina, 1966-69
Herbst, AL. et al N Engl J Med 1971,
284:878.
The Wood siblings
From: www.desexposure.com

7. Diethylstilbestrol - DES
Estradiol

8. DES Health Effects - Female
• Vaginal cancer (clear-cell adenocarcinoma)
• Gross and cellular structural abnormalities of
reproductive organs: fallopian tubes, uterus,
cervix, and vagina
• Suppression of cell-mediated immunity
• Infertility (5x)
• Preterm labor
• Uterine fibroids
• Breast cancer
• Trans-generational effects – DES granddaughters

9. DES Health Effects - Male
• Cryptorchidism
• Testicular
hypoplasia
• Epididymal cysts
• Semen
abnormalities
• Reduced fertility
• Testicular cancer

10. Lessons from DES
• The placenta is not a barrier
• Exposure to the mother can have
unexpected, delayed effects in the offspring
• Exposure to a hormonally-active chemical
may result in a variety of adverse health
effects
• Unusual diseases are easier to trace to an
environmental cause than are common
diseases

11. Embryonic Development &
Vulnerability

12. Children are More Vulnerable
to All Toxins
• Immature brain, blood/brain barrier;
• Eat, breathe & drink more per kg;
• GI & skin 2x surface area v. adult;
• Outside more & closer to ground;
• Hand/mouth behaviors;
• Mouth breathers;
• Lower enzyme levels.

13. Wts of after in utero exposure to 1 part per billion DES
Estrogenic agents and obesity
Newbold, et al. 2005.
Developmental Exposure to Estrogenic Compounds and Obesity. Birth Defects Research (Part A) 73:478–480.

14. Common Endocrine Disruptors
Banned in US
PCBs
Pesticides
DDT
DBCP
Chlordecone (Kepone)
Hexachlorobenzene
Not intentionally made
Dioxins
Furans
PAHs
Still in use
Pesticides
Atrazine
Endosulfan
Lindane
Flame retardants
PBDEs
BFRs/CFRs
Plasticizers
phthalates
bisphenol A
Heavy Metals
Lead
Mercury

15. Biomonitoring
• Increasingly being used to determine what
contaminants are in biological tissues
• Gauge of how effective policy initiatives to
limit exposure are
• Where is it happening?
– CDC – NHANES
– State initiatives – California
– Non-governmental Organizations

16. Individual v. Population Effects
• Almost always impossible to pinpoint the
cause of a human health condition to one
chemical or exposure
– Timing
– Dose
– Mixtures
• “I wonder” ?

17. The Significance of Small Effects:
160140120100806040
70 130
I.Q.
mean 100
6.0 million
"gifted"
6.0 million
"mentally retarded"

18. 5 Point Decrease in Mean IQ
160140120100806040
mean 95
70 130
2.4 million
"gifted"
9.4 million
"mentally retarded"
57% INCREASE
IN
"Mentally
Retarded”
Population
I.Q.

19. Fish
• Important source of nutrition
• Common contaminants
– PCBs
– Mercury
• FDA/EPA Advisory
– tilefish, king mackerel, shark, and swordfish
• Tuna

20. Fish recommendations
• Eat a variety of fish types
• Know about fish advisories for your region
– www.epa.gov/ost/fish/
• Use fish guides for ocean fish
– NRDC fish guides and Mercury calculator
http://www.nrdc.org/mercury)
– Monterey Bay Aquarium (http://www.mbayaq.org/)
• When cooking – remove fatty portions of fish

21. Other Dietary advice
• Dioxins and other fat-soluble contaminants
in fatty tissue – PCBs, PBDEs
- Limit consumption of high fat meat &
dairy
• Eat organic produce when possible

22. Pesticides
• Can contaminate food or drinking water
• Are also frequently used in and around
homes
– Pets
– Indoor pests
– Lawns and Gardens
– Head lice and scabies
– Rural areas

23. Neurotoxicity of Pesticides
in Children

24. Recommendations
• Eat a variety of produce
• Buy organic produce when possible
• Review guides of products most likely to be
contaminated www.foodnews.org/walletguide.php
• Wash and peel outer leaves
• Utilize IPM in the home, at work, school, other
• Use non-pesticide approaches for head lice and
scabies

25. Bisphenol A
Phthalates

26. Bisphenol A
• Over 6 billion pounds
produced each year
• Developed as estrogenic
drug 1930s
• Building block of
polycarbonate plastic
• Food can lining
• Dental sealant
7
PC

27. Animal studies
• Reproductive toxin
– Lower sperm counts
– Prostate hyperplasia/cancer
– Mammary cancer
• Developmental toxin
- altered onset of puberty
- decreased anogenital distance
- oocyte anueploidy
• Neurological toxin
• Obesogen/Insulin Resistance
7
PC

28. Policy
• BPA has not been banned in any state or
country – although legislation has been
introduced
• FDA has approved BPA as a food additive
• National Toxicology Program draft report
• Health Canada - “dangerous substance”
7
PC

29. Public perception
• Market for baby bottles changed – Walmart, Sears
• "Baby Bargains," a best-selling guide to baby products,
have advised parents to stop using bottles made of
polycarbonate plastic.
"If you are shopping for bottles, choose an
alternative made from BPA-free plastic or glass,"
"If you have polycarbonate bottles, throw them out."
7 PC

30. What are the alternatives?
• Non-polycarbonate plastic or glass baby
bottle
• Born-Free (polyamide)
• Polypropylene
• Unlined stainless steel bottle
• Eat fresh food when possible,
- frozen over canned
• Buy processed food in cardboard or brick
containers

31. Bisphenol A
Phthalates

32. Phthalates and PVC
• Make PVC flexible and soft
• Not tightly bound, migrates with use
• Ubiquitous exposure
• General Uses
- Building materials - Toys
- Clothing - Childcare Products
- Packaging - Cosmetics and
- Medical Devices personal care products
- Air fresheners
PVC3

33. Phthalates: Anti-Androgens
“Phthalate Syndrome”
– Absent testes, prostate
gland, seminal vesicles
– Testicular atrophy
– Decreased sperm count
– Decreased fertility
– Cryptorchidism
– Hypospadias –
decreased AGD
Fisher J. Reproduction.127:305-15, 2004

34. What can you do?
• Avoid buy PVC “vinyl” products
• Avoid using synthetic scents to mask
odors
• Avoid exposure to phthalates
– Fragrance free cosmetics and personal care
products
– Soft pliable plastic toys for children
• Support legislation in California that
would limit exposure to these chemicals.

35. Chemicals in Breast milk
• PCBs
• Pesticides – banned and currently in use
• Dioxins
• Flame retardants
• Plasticizers
• Heavy metals
• Solvents
• http://www.nrdc.org/breastmilk

36. Recommendations
• Benefits of breast feeding outweigh the risks
from pollution.
• Breastmilk is superior to formula because
– provides vital trace nutrients and antibodies not found
in formula
– benefits the mother by promoting weight loss and
bone strength
– promotes brain and nervous system development
– can lessen the effects of some toxic exposures

37. Baby formula is not an equivalent
substitute for breast milk.
• Formula is lacking in many of the vital trace
nutrients and antibodies found in breast milk.
– babies get sick more often than breast fed babies.
• Infant formula may contain other toxins or be
diluted with contaminated water
• Soy formulas can have very high levels of plant-
derived estrogens (phytoestrogens)
– the long term health effects are not very well studied.

38. Take home messages
• Hormonally-active agents exist in drugs,
cosmetics, dietary supplements, pesticides,
consumer products, and industrial
chemicals.
• Laboratory animal experiments suggest that
exposures to these agents could be
impacting reproductive health.
• The developing fetus, infants and children
are most vulnerable because their organs
are still developing

39. Take home messages, cont’d
• Consequences of early life exposures are
sometimes manifest until adulthood and can
be permanent and irreversible
• Chemicals can have multiple sites of action
with multiple effects.
• The impacts of exposures to mixtures of
chemicals is not understood

40. Resources
Natural Resources Defense Council
www.nrdc.org
Simple Steps
www.simplesteps.org