To conclude, the results from in vitro studies have shown the phthalates’ effect on apoptosis and the proliferation of cells within the reproductive system. Interestingly, a Chinese study including 84 healthy men aged 29.8 ± 6.6, showed that the urinary levels of ∑DEHP were positively correlated with testosterone . Based on the results of cohort studies, we could not draw conclusions on the relationship between the phthalate exposure and effects on FSH and LH levels in men. Other studies observed associations between postnatal exposure to phthalates in healthy and infertile men and decreased testosterone 80,194,195,196,197,198. The conflicting results in testosterone levels can be likely explained by the timing of exposure to phthalates and by reproductive disorders occurrence. Besides, the phthalates modification of gene expression can also influence the onset of cancer. The function of some genes regulating male and female reproductive system development . Altered gene expression directly influences reproductive health and hormone secretion 238,241. Contrarily, at 13 mg/kg/day, the mixture of phthalates (DBP, BBzP, DEHP, DiNP) increased the expression of Lhr in male C57/BL6 mice . Altered hormonal balance can be influenced by the phthalates’ impact on the intracellular signaling. For example, in personal care products, phthalates are often included under broader terms like "fragrance" or "parfum," Liang said. The good news is that phthalates have a short half-life and leave the body within a few days, experts said. Manufacturers often search for replacements to chemicals that science has linked to health harms and that are being regulated by federal and state governments. "The broader concern is really about phthalates as a class and focusing on one or two at a time may underestimate the overall risk." "That said, I would not interpret this as meaning only these two phthalates matter," he said. "DiNP was included because it is a common replacement for DEHP and is increasingly relevant as industries shift away from older phthalates. "Specifically, DEHP has been one of the most widely studied phthalates in relation to preterm birth, so there is a stronger epidemiologic basis for modeling its contribution," Liang, who wasn’t involved in the research, said in an email. NIEHS experiments on DES successfully replicated and predicted health problems, which was useful in discovering how DES may harm wellbeing. In essence, your contact with these chemicals may occur through diet, air, skin, and water. Contact with these chemicals may occur through air, diet, skin, and water. There are several ways to be exposed to phthalates, mainly via inhalation, ingestion, and transplacental transition. Primary and secondary metabolites of the selected diesters of phthalates . Dialkyl phthalates are metabolized to monoalkyls by enzymes that exhibit lipase and esterase activity . A critical developmental window for reproductive system development is during gonadogenesis (5th–18th week of gestation). Moreover, they are capable of transplacental transition, and therefore they can exert their toxic effects within embryonic and fetal development . This work began with studies on the endocrine-disrupting effects of the drug diethylstilbestrol (DES). NIEHS-supported research leads to a greater understanding of how endocrine-disrupting chemicals may harm our health and cause disease. For more than three decades, NIEHS has been a pioneer in conducting research on the health effects of endocrine disruptors. This observation leads scientists to think that endocrine-disrupting chemical exposures, even at low amounts, can alter the body’s sensitive systems and lead to health problems. EDCs cannot be completely avoided or removed; however, you can make informed choices to reduce exposure and risk of any potential health effects. In particular, exposure to phthalates during the prenatal, early childhood, and pubertal periods, when the testosterone-producing Leydig cells in the testes develop (46), may dysregulate testosterone production throughout the life course, with consequences for reproductive function (47). These broad health sequelae of decreased testosterone reinforce the need to identify preventable causes of male hypogonadism, including environmental exposures to possible endocrine disrupting chemicals. Research has linked phthalates with reproductive problems such as genital malformations and undescended testes in baby boys and lower sperm counts and testosterone levels in adult males. Therefore, it is vital to conduct more epidemiological and experimental studies to understand whether and how phthalates can induce the cancer of male reproductive organs. The objective of this review was to analyze the phthalates’ effects on the reproductive system and their endocrine and intracellular mechanisms (see Figure 3). Based on the results from in vitro studies, phthalates increase Ca2+ levels in the gonadal cells to inhibit the maturation and activation of these cells. In particular, we observed differences in HMW concentrations by age, such that younger men were more highly exposed than older men. The heterogeneity of associations across age groups that we observed may have several explanations, including an age-period-cohort effect. This was previously reported by Meeker and Ferguson, specifically among men age 40 to 60 (28). In addition, there was little variation in blood draw timing across strata of age or race/ethnicity, thus yielding a sample that was similarly distributed with respect to demographics and covariates compared with the total original sample (data not shown). The increased use of phthalates and other EDs in the plastic products industry in the last 70 years can explain the worldwide higher prevalence of reproductive disorders. Phthalates modulate levels of Ca2+ levels in the gonadal cells to disrupt the maturation and activation of these cells. At the intracellular level, phthalates act via interaction with the signaling of membrane receptors GnRHR, LHR, FSHR, which regulate steroidogenesis. In males, phthalates can induce testicular dysgenesis syndrome (TDS), which is connected with impaired spermatogenesis. This paper represents an extensive review of results from in silico, in vitro, in vivo studies, and epidemiological studies with the focus on human reproductive health. Phthalates increase the levels of Ca2+ levels in the gonadal cells to inhibit the maturation and activation of these cells.