Synergistic Disruption of External Male Sex Organ Development by a Mixture of Four Antiandrogens

Sofie Christiansen, Martin Scholze, Majken Dalgaard, Anne Vinggaard, Marta Axelstad Petersen, Andreas Kortenkamp, Ulla Hass

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By disrupting the action of androgens during gestation, certain chemicals present in food, consumer products and the environment can induce irreversible demasculinisation and malformations of sex organs among male offspring. However, the consequences of simultaneous exposure to such chemicals are not well described, especially when they exert their actions by differing molecular mechanisms. Objectives: To fill this gap, we investigated the effects of mixtures of a widely used plasticizer, di(2-ethylhexyl) phthalate (DEHP), two fungicides present in food, vinclozolin and prochloraz, and a pharmaceutical, finasteride, on landmarks of male sexual development in the rat, including changes in anogenital distance, retained nipples, sex organ weights and malformations of genitalia. These chemicals were chosen because they disrupt androgen action according to differing mechanisms of action. Results: Strikingly, the effect of combined exposure to the selected chemicals on malformations of external sex organs was synergistic, and the observed responses were greater than would be predicted from the toxicities of the individual chemicals. In relation to other hallmarks of disrupted male sexual development, including changes in anogenital distance, retained nipples, and sex organ weights, the combined effects were dose additive. When the four chemicals were combined at doses equal to no-observed-adverseeffect levels estimated for nipple retention, significant reductions in anogenital distance were observed in male offspring. Conclusions: Since unhindered androgen action is essential for human male development in foetal life, these findings are highly relevant to human risk assessment. Evaluations that ignore the possibility of combination effects may lead to considerable underestimations of risks associated with exposures to chemicals that disrupt male sexual differentiation.
Original languageEnglish
JournalEnvironmental Health Perspectives
Issue number12
Pages (from-to)1839-1846
Publication statusPublished - 2009


  • Antiandrogens
  • Combination effects
  • Dose addition
  • Independent action
  • Mixtures
  • Cumulative effects


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