The endocrine disrupting potential of phytoestrogens was first noticed in Australia in the 1940s when abnormally high rates of infertility, abortion, and reproductive abnormalities in newborn lambs were observed in ewes grazing on clover rich pastures (Bennetts and Underwood,
1951; Bennetts et al.,
1946). It was ultimately determined that the steroid-like flavonoid phytoestrogens, most notably coumestrol, were responsible for the observed effects (Adams,
1995a,
b; Braden et al.,
1967). Decades later, a singular case of infertility and liver disease in captive cheetahs placed on a soy-based diet was ultimately attributed to the same class of compounds (Setchell et al.,
1987). These incidents are reminiscent of the DDT story in wild bird populations, and have raised questions regarding the potential risk flavonoid phytoestrogens might pose to humans.
The two major classes of phytoestrogens are the lignans and the isoflavonoids. Lignans are minor components of cell walls and the highest concentrations are found in flaxseed (linseed) products, pumpkin seeds, green tea, coffee, and other fiber-rich foods (Axelson et al.,
1982; Kuhnle et al.,
2008; Mazur and Adlercreutz,
2000; Penalvo et al.,
2008; Thompson et al.,
1991,
2006). The isoflavonoids are most prevalent in legumes, especially soybeans and soy-based foods including soy infant formula, tofu and soy milk, but detectable levels also occur in fruits, vegetables, whole grains, and even some alcoholic beverages (Adlercreutz and Mazur,
1997; Fletcher,
2003; Franke et al.,
1998a; Lapcik et al.,
1998; Reinli and Block,
1996; Setchell et al.,
1998). Dietary supplements containing high levels of isoflavonoid phytoestrogens are now widely available (Setchell et al.,
2001). Of the many isoflavonoids found in soy, the most intensely scrutinized are genistein and daidzein.
Considerable attention is now being paid to the potential endocrine disrupting properties of isoflavonoids because soy consumption is widely promoted as being healthful and has been associated with reduced risk of cardiovascular disease and hormone dependent cancers (Adlercreutz and Mazur,
1997; Clarkson,
2002; Demonty et al.,
2003; Peeters et al.,
2003). In 1999, the US Food and Drug Administration (FDA) approved the health claim that daily consumption of 25

g of soy protein can reduce the risk of coronary artery disease (Food and Drug Administration,
1999). Soy consumption is increasing among all age groups, especially infants and children (Cao et al.,
2009; Setchell,
2001; Strom et al.,
2001). Genistein and other phytoestrogens readily cross the placenta indicating that fetal exposure is also potentially consequential (Todaka et al.,
2005). Total isoflavone content in soy infant formula varies but is consistently high among soy foods, averaging near 40

μg total isoflavones per gram of formula (Franke et al.,
1998b; Johns et al.,
2003; Setchell and Welsh,
1987; Setchell et al.,
1997). This translates to a daily intake of approximately 6–9

mg/kg body weight per day, an amount, when adjusted for body weight, which is four to seven times higher than the amount consumed by adults on a traditional soy-based Asian diet or meeting the FDA guidelines (Barnes,
1995) and considerably higher than any synthetic EDC.
So is there cause for concern? The sheep and cheetah cases are disquietingly similar to the bird and other wildlife studies of the 1970s which ultimately identified the endocrine disrupting properties of DDT. But even today the question of whether or not DDT can impact human health is controversial, and such is the case with soy phytoestrogens. Is there any reasonably good evidence that phytoestrogens can have long term adverse health effects in humans following developmental exposure? A pair of studies on Puerto Rican girls associated neonatal phytoestrogen exposure with advanced pubertal onset, but a number of confounding factors including the use of potent estrogens in meat production, make the data problematic and difficult to interpret (Freni-Titulaer et al.,
1986; Schoental,
1983). A more recent, retrospective cohort study found that young women fed soy-based infant formula as part of a controlled, University of Iowa feeding study reported longer menstrual bleeding and menstrual discomfort than those who were fed a non-soy based formula as babies (Strom et al.,
2001). Beyond these epidemiology studies, very little is known about how exposure to soy phytoestrogens, either in the womb or in infancy, impacts female reproductive health or behavior in humans.
Data from animal research is more abundant. Neonatal exposure to genistein advances pubertal onset, increases the length of the estrous (menstrual) cycle and hastens the onset of persistent estrus in rodents. Female mice treated with 0.5–50

mg/kg genistein for only the first 5

days of life give birth to fewer live pups over time compared to untreated control animals, with fertility most strongly impacted at the highest dose (Jefferson et al.,
2005). This acceleration of reproductive senescence could result from disruption anywhere within the HPG axis including the ovary and brain. Detailed work in mice by Jefferson and colleagues has revealed that genistein can interfere with ovarian differentiation resulting in ovarian malformations indicative of impaired fecundity such as multi-oocyte follicles, and attenuated oocyte cell death (Jefferson et al.,
2002,
2006,
2007). Ovarian defects, including the absence of corpora lutea, the presence of large antral-like follicles with degenerating or no oocytes and numerous ovarian cysts have also been observed following neonatal genistein exposure in rats (Kouki et al.,
2003) (Figure ).
Recent studies in our laboratory have found that the organization of sexually differentiated neural pathways within the hypothalamus is also vulnerable to neonatal endocrine disruption by genistein. We determined that advanced vaginal opening and abnormal estrous cyclicity, induced by neonatal exposure to 10

mg/kg genistein, is accompanied by an impaired ability to stimulate GnRH neuronal activity (as measured by the immunoreactivity of both of GnRH and Fos) following ovariectomy and hormone priming (Bateman and Patisaul,
2008) (Figure ). This observation indicates that neonatal genistein exposure has a masculinizing effect on the female HPG axis. Although GnRH neurons express ERβ throughout development (Herbison and Pape,
2001; Hrabovszky et al.,
2000,
2001) and thus could potentially respond to neonatal genistein directly, it is generally accepted that hormonal and other environmental signals are largely conveyed to GnRH neurons from other estrogen-responsive neurons clustered in different regions of the hypothalamus. In rodents, the two most significant regions appear to be the anterior ventral periventricular (AVPV) and arcuate (ARC) nuclei (Gu and Simerly,
1997; Polston et al.,
2004; Polston and Simerly,
2006; Shughrue et al.,
1997; Simerly et al.,
1990) both of which contain sexually dimorphic populations of neurons that express the KiSS-1 gene. This gene codes for a family of peptides called kisspeptins (previously called metastins), and rapidly emerging evidence indicates that kisspeptin neurons are essential for coordinating pubertal onset and steroid feedback on GnRH neurons in many species, including humans (Kauffman et al.,
2007a; Navarro et al.,
2004; Smith et al.,
2006a,
b). AVPV kisspeptin neurons are more numerous in females than males and are thought to be essential for steroid positive feedback and the initiation of the preovulatory GnRH surge (Clarkson et al.,
2008; Gottsch et al.,
2004; Irwig et al.,
2004; Kauffman et al.,
2007a, Roa et al.,
2006; Smith et al.,
2006b). In contrast, KiSS mRNA expression in the ARC is not thought to be sexually dimorphic and appears to be important for the regulation of steroid negative feedback (Kauffman et al.,
2007a). We have now shown that neonatal exposure to 10

mg/kg genistein can significantly decrease the density of neuronal fibers immunolabeled for kisspeptin in the AVPV but not the ARC of female rats (Bateman and Patisaul,
2008; Patisaul et al.,
2009b) indicating that disrupted organization of the kisspeptin signaling pathways may be a novel yet fundamental mechanism by which a suite of reproductive abnormalities are induced including disrupted timing of pubertal onset, irregular estrous cycles and premature anovulation.
Interestingly, animals exposed to genistein neonatally remained capable of displaying lordosis when ovariectomized, primed by the sequential administration of estradiol benzoate and progesterone, and paired with vigorous males (Figure ). Lordosis behavior is also retained by female rats neonatally exposed to agonists selective for either ERα or ERβ but not estradiol benzoate suggesting that agonism of both ER subtypes may be needed to fully defeminize the behavior (Patchev et al.,
2004; Patisaul et al.,
2009a). It may also take a longer exposure or higher doses, a possibility which illustrates the important concepts of dose and timing when considering the potential effects of EDCs. Further complicating the issue is a report that selective agonism of ERβ results in a statistically significant reduction, but not elimination, of lordosis behavior in mice (Kudwa et al.,
2006). This could be a species difference in sensitivity or the relative role ERβ plays in the organization of the neuroendocrine pathways that mediate the lordosis response. Further work will be needed to clarify this issue.
The mechanisms by which genistein and the other phytoestrogens influence sex-specific physiology are likely diverse. Genistein has a higher relative binding affinity for both ERα and ERβ
in vitro than most other EDCs and a higher binding affinity for ERβ that for ERα (Kuiper et al.,
1998). Genistein is also a potent inhibitor of tyrosine protein kinases (Boutin,
1994; Piontek et al.,
1993), which catalyze phosphorylation of their own tyrosine residues and those of other proteins, including growth factors involved in tumor cell proliferation. In addition, genistein can also inhibit DNA topoisomerases I and II, enzymes essential for DNA replication (Kurzer and Xu,
1997; Okura et al.,
1988) and may also work through epigenetic mechanisms involving both hyper and hypomethylation (Dolinoy et al.,
2006; Tang et al.,
2008). A further complication is the observation that effects of genistein administration at low doses are compounded when co-administered with other EDCs (Kurzer and Xu,
1997; You et al.,
2002). Mixture effects of phytoestrogens, as with most other EDCs, are generally unappreciated.