Table 13.
Associations between DEHP exposure and testosterone.
| Reference; Study confidence; N | Transformation | Effect estimate | Metabolite (ng/mL) [median unless otherwise specified] | Exposure IQR (or as specified) | Testosterone effect estimate |
|---|---|---|---|---|---|
| ∑DEHP | |||||
| Mendiola et al. (2011); Medium; 363 | Log10 transformed | β (95% CI) for 1 unit increase | 0.24 nmol/mL | 0.1−0.5 | −0.01 (−0.04, 0.03) |
| Meeker et al. (2009); Medium; 425 | Ln-transformed exposure | β (95% CI) for IQR increase | 0.31 nmol/mL | 0.2−0.7 | −6.35 (−17.8, 5.1) |
| Chang et al. (2015); Low; 176 | Ln-transformed exposure and outcome | β (95% CI) for IQR increase | 0.15 nmol/mL (mean) | 0.98 (0.9, 1.1)Ŧ | |
| Wang et al. (2015c); Medium; 1,040 | Ln-transformed exposure and outcome | % difference (95% CI) 1 unit increase | 7.9 (MEOHP) | 3.9–8.5 | −3.7% (−8.0, 0.6) |
| Meeker and Ferguson (2014); Medium; 160 (12–19 yr) | None reported | % change (95% CI) with IQR increase | 4.9 (MEOHP) | 3.0–7.4 | −8.42% (−24.5, 11.0) |
| 267 (20–40 yr) | 4.2 (MEOHP) | 2.8–7.1 | 0.42 (−5.8, 7.1) | ||
| Specht et al. (2014); Medium; 589 | Means (95% CI) for <25th, 25th−75th, >75th percentile | 0.01 nM (Proxy DEHP) | 0.01−0.14 | Q1: 15.4 (14.3−16.7) Q2: 14.8 (14.0, 15.7) Q3: 14.1 (13.1−15.1) p trend <0.05 |
|
| MEOHP | |||||
| Den Hond et al. (2015); Low; 120 | Ln-transformed exposure | β ± SE | 7.7 | 3.9−14.0 | −0.03 ± 0.04 |
| Pan et al., 2016; Pan et al. (2015); Medium; 1,066 | Ln-transformed exposure and outcome | % change (CI) | 8.4 | 4.8–14.3 | −1.6% (−2.2,1.0) |
| Axelsson et al. (2015a); Medium; 314 | Ln-transformed exposure and outcome | Mean difference (Q4 vs. Q1) | 9.6 | 0.5−1,100 (range) | −1.0 (−9.7, 8.7) |
| Park et al. (2010); Low; 25 | Ln-transformed exposure | Correlation coefficient | 14 (pre-shift) | 9.2−19 | −0.33 (p = 0.1) |
| MEHP | |||||
| Jurewicz et al. (2013); Medium; 269 | Log-transformed exposure | β (p) | 8.8 | 0.6–136 (range) | −0.29 (p = 0.04) |
| Han et al. (2014); Medium; 232 | None reported | Partial correlation coefficient | 1.1 | 0.0–23.8 (5th–95th) | −0.05 |
| Pan et al. (2006); Medium; 137 | Log10 transformed outcome | Partial correlation coefficient | 562/5 μg/g creatinine (exposed/unexposed) | 210–1,884/3.7–10 | −0.2 (free testosterone) |
p < 0.05, results that support an association are shaded. Dark gray represents one or more of the following: p < 0.05, large effect size (e.g., OR ≥ 1.5, β ≥ −0.5, % difference ≥ 1.0%), or exposure-response trend across categories of exposure. Light gray represents other supportive results.
Q = quartile.
Ŧ Coefficient was calculated by study authors with back-transformation of both hormone and phthalate metabolite concentrations. A coefficient < 1.0 indicates a multiplicative decrease in hormone level for an IQR change in exposure.
Units for testosterone differed across studies: ng/mL (Jurewicz et al., 2013, Meeker and Ferguson, 2014, nmol/L (Han et al., 2014, Axelsson et al., 2015a, 2015b, Mendiola et al., 2011, Chang et al., 2015, Pan et al., 2015), nmol/mL (Specht et al., 2014), pg/mL (Pan et al., 2006), ng/dL (Meeker et al., 2009; Den Hond et al., 2015; Wang et al., 2015a, 2015b, 2015c).