When Dr. Ashley Eskew speaks to a new patient for the first time, she always tells them about how hormone-disrupting chemicals in their processed food packaging, beauty products, and furniture might be impacting their ability to conceive.
Eskew is a North Carolina-based fertility doctor and co-founder (along with her husband, board-certified integrative medicine physician Will Haas) of OvulifeMD, a website that provides evidence-based dietary, environmental, and lifestyle modification suggestions to women who struggle to conceive or have experienced multiple miscarriages.
So when I sent her news stories about all the different endocrine disruptors found in women’s and children’s clothing, she was shocked.
Why aren’t we talking about this in the medical community? – Dr. Ashley Eskew
BPA has been found at high levels in polyester/spandex sports bras, socks and shirts. When the Canadian Broadcasting Corporation had thirty-eight pieces of children’s clothing tested from ultra-fast-fashion brands Zaful, AliExpress, and Shein, it found that one in five had elevated levels of toxic chemicals like lead, PFAS, and phthalates.
Most notoriously, the period panty brand Thinx recently settled a lawsuit stemming from a test that found high levels of fluorine in the crotch, indicating intentionally-added PFAS. And high levels of PFAS have also been found in children’s clothing and school uniforms. These are all reproductively toxic chemicals.
“I just felt so uninformed and out of the loop,” Eskew said. “Why aren’t we talking about this in the medical community? We’re looking at it in all of these other things, from the dust we bring into the house, to the flame retardant that’s on your couch, to the creams and lotions. But what about what’s touching your skin all day every day? Like, why hasn’t this come up yet?”
I had reached out to Eskew for an interview while researching my book To Dye For: How Toxic Fashion Is Making Us Sick – and How We Can Fight Back. I wanted to know how a fertility doctor thinks about endocrine disruptors in consumer products. But because fashion doesn’t come with an ingredient list – and this topic is so little talked about – it was news to her.
It is deeply disturbing, I think, to not have an ingredient label on your clothes, once you realize all of these things are in there. – Dr. Ashley Eskew
“The children’s clothing, that’s the thing that got me as well,” she said. “One of the pictures that was in one of the articles that you linked to, it’s a dress with a princess on it, which is the exact dress that I sent my niece for her birthday. And I mean, that’s an especially high-risk population.”
Eskew continues, “It is deeply disturbing, I think, to not have an ingredient label on your clothes, once you realize all of these things are in there.”
Globally, we are in a reproductive health crisis. In 2020, the market for assisted reproduction was estimated to be $2.3 billion and growing. According to researcher Shanna H. Swan’s book Count Down: How Our Modern World Is Threatening Sperm Counts, Altering Male and Female Reproductive Development, and Imperiling the Future of the Human Race, women seeking fertility treatment in the US who have a diminished ovarian reserve—a low number of eggs to give in IVF—increased 37 percent from 2004 to 2011. Miscarriage rates in women are also increasing by about 1 percent a year, and it’s not because we’re waiting longer to start families—the most dramatic fertility reductions are in younger women.
Researchers put the blame squarely on endocrine disruptors: chemicals that interfere with our body’s ability to regulate its hormones. They include a lot of fashion’s favorite finishes and ingredients: lead, mercury, arsenic, phthalates, APEOs, PFAS, and bisphenol A (BPA) and its cousins BPS and BPF. There are more than a dozen different types of phthalates alone, and the majority of them are used to make the PVC soft for things like cheap pleather skirts and jelly shoes.
Researchers put the blame [of reproductive issues] squarely on…chemicals that interfere with our body’s ability to regulate its hormones
There’s evidence that damage caused by endocrine disruptors can be passed from mothers and fathers to children, increasing their risk of developing reproductive abnormalities. The effect of phthalate exposure in pregnant animals and humans on their male babies’ genitals has even been given a name: phthalate syndrome. It’s especially serious when exposure happens between weeks eight and twelve of pregnancy in women.
This isn’t just an issue for those who want to start a family, though, or even those concerned about their low sex drive or painful periods. As anyone with a thyroid disease can tell you, the endocrine system regulates all the important systems in your body, including your immune system, your brain, your metabolism, and your cardiovascular system. It governs weight management and your energy levels, not to mention your skin’s appearance and your ability to fend off illness. PFAS, for example, has been linked to several types of cancer, thyroid disfunction, birth defects, immune system suppression, and obesity.
It’s anecdotal, but Eskew has noticed that a lot of her patients, more than in the general population, have autoimmune thyroiditis (Hashimoto’s disease), where immune antibodies attack their own thyroid. She’s seen in her own practice what happens when women start making lifestyle changes to reduce their exposure to endocrine disruptors. Not only does their egg quality improve, but other thyroid-related health issues like fatigue, constipation, and atopic dermatitis are also ameliorated. “You remove that insult, and it’s like a new person, a new patient altogether. So I definitely think that there’s a big link there,” she said.
[D]amage caused by endocrine disruptors can be passed from mothers and fathers to children, increasing their risk of developing reproductive abnormalities
So should we be worried about the endocrine disruptors found in our clothing? Absolutely. Endocrine disruptors don’t follow the old adage, “The dose makes the poison.” Traditional toxicology has always assumed that the smaller the dose, the less the harm. But an emerging theory is that endocrine disruptors follow a dose-poison U curve: chaotic effects at high doses, more subtle effects at middling doses, and unpredictable, cascading effects again at tiny doses. More and more researchers agree that there is no “safe” dose of endocrine disruptors.
What’s scary is that, according to Swan, an amount of an endocrine-disrupting chemical so small as to be equal to a drop in an Olympic-size swimming pool can cross the placenta and measurably affect an embryo, and those changes can be permanent. The doses we are talking about, at parts per billion, are absolutely the kinds you can get from wearing fashion containing these substances.
For example, research out of Notre Dame shows that PFAS comes off of treated textiles at the parts-per-million level. That’s one thousand times more.
“The big ones that we talked about, like phthalates, BPA, lead, heavy metals, all of those things add up over time,” Eskew said. “If we get a small amount from our food, and if we get a small amount from our clothes, and we get a small amount from our personal care products, then what does that look like at the end of the day? That additive effect, if you actually looked at that, then I guarantee that all of these things would be high enough to cause some sort of symptom and problem. But we’ve normalized that. How much of today’s society has normalized feeling fatigued? Or having dry, itchy skin, or having some sort of reactive asthma to something, like, Oh, well, I just wheeze sometimes, like not actually investigating that further?”
“The good news is, especially in the case of BPA and that sort of thing, they have a short half-life. So small changes that you make today will result in a difference tomorrow or the next day or the next day,” continues Eskew.
It’s true. Bisphenols like BPA and phthalates are water soluble—we pee them out fairly quickly. If our exposure completely stopped today, they would be mostly gone within a week. But we are exposed to them from such a wide variety of places on such a regular basis, their levels in the average American body stay about the same. Heavy metals and PFAS, that “forever chemical,” on the other hand, are persistent, building up in our fat and hanging out doing their damage for years and years. The quicker we can stop our exposure to them, the better.
We’d better start now.
There are a few ways to reduce your exposure to endocrine disruptors in clothing. First, try to avoid synthetic clothing whenever possible, especially for things you’ll wear next to your skin when you sweat, like underwear, sports bras, socks, and leggings. Next, avoid clothing that promises to be stain-repellent or water-repellent, such as outdoor gear, unless it clearly states it does not have any PFAS. Avoid ultra-fast fashion brands such as SHEIN, Zaful, Boohoo, Missguided, or Romwe. If you need affordable clothing, try secondhand items of natural fiber that have been washed and worn already, or brands with robust chemical management programs designed to “establish best practices and procedures for improving inputs, reducing chemical use and conducting careful oversight and operations of wastewater treatment.”
And if you see that California label stating that a fashion item is reproductively toxic, believe it! Don’t put that item in your cart.
I know this is a lot to take in, but this information is also meant to be empowering. If we can spread the word about the severity of endocrine disrupting chemicals in our fashion, we can create a movement demanding accountability from the fashion industry. We should also demand robust legal protections so that anyone can go to the store and trust that whatever they put in their cart won’t damage their reproductive—or overall—health.