PFAS Information for Clinicians Factsheet

Gold icon of a PFAS chemical structure containing groups of circles representing atoms and lines representing chemical bonds.
  • Per- and polyfluoroalkyl substances (PFAS) are a family of thousands of synthetic chemicals; relatively few have been studied for their effect on health
  • Used widely to reduce friction or resist oil, water, and stains
  • Widespread and persistent in the environment
  • Among studied PFAS: absorbed in intestines and lungs; bind to serum and tissue proteins; most not metabolized; half-lives range from a few days to 8+ years
Human Exposure
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  • Nearly all people in the U.S. have had exposure to PFAS
  • PFOS, PFOA, and PFHxS exposure is decreasing in the U.S. population, in part because of production phase-outs
  • Population exposures to substitute PFAS (e.g., GenX) are not well studied
  • Communities with PFAS contamination of water or food are often near facilities that have manufactured, used, or handled PFAS
  • Ingestion of PFAS in water and food is a main route of exposure; ingestion of dust and residue from PFAS-containing products can also result in exposure
  • Inhalation is not a typical route of exposure for the general population but can occur with PFAS-containing dust, aerosols, or fumes
  • Children can be exposed by drinking formula mixed with PFAS-containing water, drinking breastmilk from persons exposed to PFAS, ingesting dust or dirt, and through hand to mouth behaviors with textiles treated with stain protectants
  • Some PFAS cross the placenta and enter umbilical cord blood
Health Effects
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  • Research is ongoing to understand the mechanisms of PFAS toxicity
  • The epidemiological evidence suggests associations between increases in exposure to (specific) PFAS and certain health effects
    • Increases in cholesterol levels (PFOA, PFOS, PFNA, PFDA)
    • Small decreases in birth weight (PFOA, PFOS)
    • Lower antibody response to some vaccines (PFOA, PFOS, PFHxS, PFDA)
    • Kidney and testicular cancer (PFOA)
    • Pregnancy-induced hypertension or preeclampsia (PFOA, PFOS)
    • Changes in liver enzymes (PFOA, PFOS, PFHxS)
  • The risk of health effects associated with PFAS depends on
    • Exposure factors (e.g., dose, frequency, route, and duration)
    • Individual factors (e.g., sensitivity and chronic disease burden)
    • Other determinants of health (e.g., access to safer water and quality healthcare)
Clinical Evaluation and Management
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  • Main goals are to
    • Identify and reduce PFAS exposures
    • Promote standard age-appropriate preventive care measures for physical health, mental health, and wellness
  • Clinical presentation: PFAS toxicity is not associated with characteristic signs or symptoms
  • Taking an exposure history can help identify PFAS exposures and determine actions to reduce exposures; ask about possible current and past PFAS exposure sources, durations, frequency, and magnitude
  • Exposure reduction strategies follow from the exposure history; examples include
    • Installing water filtration system or using an alternative water source
    • Limiting or avoiding consumption of contaminated fish, meat, eggs, or dairy
    • Choosing products without PFAS when possible
  • Breastfeeding is optimal due to its many benefits; clinicians can assist patients in their decision to breastfeed based on factors specific to the patient and child
  • Clinicians can counsel patients on whether to pursue blood testing with an understanding of the benefits and limitations of PFAS testing:
    • Results (current levels of PFAS in the blood) could reflect recent exposures or past exposures in the case of PFAS with long half-lives
    • PFAS blood test results do not identify sources of exposure
    • Results do not indicate whether a current illness can be attributed to PFAS exposure or predict future health problems
    • Comparing PFAS results across laboratories can be difficult
    • Potential relief from psychological distress if PFAS levels are normal
    • Having information that could guide exposure reduction decisions
    • Potential for false positives from screening based on PFAS blood test results and iatrogenic complications from additional evaluation and treatment
  • ATSDR has not developed health-based screening blood levels for PFAS
  • No approved medical treatments are available to remove PFAS from the body
Additional Expertise
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  • Other professionals can help with exposure histories and reduction methods, and patient evaluation and monitoring/treatment plans:
    • Board-certified clinicians specializing in occupational and environmental medicine, medical toxicology, and pediatric environmental health
    • Occupational health clinicians
    • State or local health/environmental departments



Per- and polyfluoroalkyl substances


Perfluorodecanoic acid


Perfluorohexane sulfonic acid


Perfluorononanoic acid


Perfluorooctanoic acid


Perfluorooctane sulfonic acid

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