Association of Di(2-ethylhexyl) Phthalate Exposure with Reproductive Hormones in the General Population and the Susceptible Population: A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational epidemiological studies
PubMed 39568700 · doi:10.1021/envhealth.4c00046
What was done
Authors conducted a systematic review and meta-analysis searching three databases through January 31, 2024. They included 37 epidemiological studies across eight countries comprising 28,911 total participants. Exposure was evaluated via urinary di(2-ethylhexyl) phthalate (DEHP) metabolites. Associations with reproductive hormones were reported by sex, with subgroup analyses by age, subfertility status, and national sociodemographic index (SDI). The effect of maternal exposure during pregnancy on children's reproductive hormones was also evaluated.
What was found
The abstract reports directional findings without specific effect sizes, confidence intervals, or p-values. In men overall, DEHP was positively correlated with sex hormone-binding globulin (SHBG) and inversely correlated with total testosterone (TT), free androgen index (FAI), and follicle-stimulating hormone (FSH). Hormonal suppression was more pronounced in infertile men than fertile men of reproductive age. In women, postmenopausal individuals showed associations between DEHP and lower TT and estradiol (E2). No significant association was observed between prenatal DEHP metabolites and children's hormone levels.
Why it matters
This review synthesizes population-level epidemiological data indicating that DEHP exposure is linked to suppressed androgen levels, identifying infertile men and postmenopausal women as especially vulnerable groups.
Limits
The abstract provides no numerical effect estimates, variances, or test statistics. All pooled primary studies were observational, precluding causal inference and leaving open potential unmeasured confounding. Urinary metabolites also reflect short-term exposure rather than long-term cumulative burden.