Table 20.

Evidence profile table for male reproductive effects of DIBP.

Outcome	Studies (design in parentheses)	Factors that increase confidence	Factors that decrease confidence	Summary of findings	Confidence judgement for outcome	Confidence judgement for overall hazard
Testosterone	Medium confidence Meeker and Ferguson, 2014 (CS) Pan et al., 2015 (CS) Low confidence Chang et al., 2015 (CS) Den Hond et al., 2015 (CS)	Consistency Minimal risk of bias in medium confidence studies	Few studies available Association in one study only observed in adolescents	Inverse associations between DIBP exposure and testosterone levels in 3/4 studies (Meeker and Ferguson, 2014, Pan et al., 2015, Chang et al., 2015), 2 of which were statistically significant. No studies examined exposure-response gradient (Table 15).	⨁⨁◯ MODERATE	⨁⨁◯ MODERATE Based on testosterone and supported by slight evidence in other outcomes, with explanation for weaker observed associations (i.e., sensitivity and few available studies). Results for DBP, a structurally similar phthalate are also supportive.
Anogenital distance, semen parameters, time to pregnancy hypospadias/cryptorchidism					⨁◯◯ SLIGHT
Pubertal development					◯◯◯ INDETERMINATE

C: cohort, CC: case-control, CS: cross-sectional.