The primary route of elimination of PFAAs is through the kidney in the urine (Han et al., 2008). Other important clearance pathways include menstruation (Harada et al., 2005; Taylor et al., 2014; Park et al., 2019; Ding et al., 2020), pregnancy (Monroy et al., 2008) and lactation (Bjermo et al., 2013). Sex hormones have been identified as a major factor in determining the renal clearance of PFAAs. One study examined the role of sex hormones and transport proteins on renal clearance and observed that, in ovariectomised female rats, oestradiol could facilitate the transport of PFAAs across the membranes of kidney tubules into the glomerular filtrate, resulting in lower serum concentrations (Kudo et al., 2002).

Han X, Mingoia R, Snajdr S, Yang C, Nabb D. Uptake of perfluorooctanoate in freshly isolated hepatocytes from male and female rats. Toxicol Lett 2008;181:81–86.

Harada K, Inoue K, Morikawa A, Yoshinaga T, Saito N, Koizumi A. Renal clearance of perfluorooctane sulfonate and perfluorooctanoate in humans and their species-specific excretion. Environ Res 2005;99:253–261.

Taylor KW, Hoffman K, Thayer KA, Daniels JL. Polyfluoroalkyl chemicals and menopause among women 20-65 years of age (NHANES). Environ Health Perspect 2014;122:145–150.

Park SK, Peng Q, Ding N, Mukherjee B, Harlow SD. Determinants of per- and polyfluoroalkyl substances (PFAS) in midlife women: evidence of racial/ethnic and geographic differences in PFAS exposure. Environ Res 2019;175:186–199.

Ding N, Harlow SD, Batterman S, Mukherjee B, Park SK. Longitudinal trends in perfluoroalkyl and polyfluoroalkyl substances among multiethnic midlife women from 1999 to 2011: the Study of Women’s Health Across the Nation. Environ Int 2020;135:105381.

Monroy R, Morrison K, Teo K, Atkinson S, Kubwabo C, Stewart B, Foster WG. Serum levels of perfluoroalkyl compounds in human maternal and umbilical cord blood samples. Environ Res 2008;108:56–62.

Bjermo H, Darnerud PO, Pearson M, Barbieri HE, Lindroos AK, Nälsén C, Lindh CH, Jönsson BAG, Glynn A. Serum concentrations of perfluorinated alkyl acids and their associations with diet and personal characteristics among Swedish adults. Mol Nutr Food Res 2013;57:2206–2215.

Kudo N, Katakura M, Sato Y, Kawashima Y. Sex hormone-regulated renal transport of perfluorooctanoic acid. Chem Biol Interact 2002;139:301–316.