By Allen P. Green, M.D. April 2026
If you have been following the news the past few weeks, you have probably seen two stories about “forever chemicals” that deserve to be read together.
On March 30, researchers at the University of Colorado Anschutz Medical Campus published a study in ACS Chemical Research in Toxicology identifying a specific PFAS compound, perfluorodecanoic acid or PFDA, as the most toxic during fetal craniofacial development. Two weeks later, on April 13, Texas Attorney General Ken Paxton launched a formal investigation into whether Lululemon has been selling activewear containing these same chemicals to customers who believed they were buying a “wellness” product.
The science on these compounds is clarifying faster than the consumer-facing conversation has caught up with. For patients who have been asking us about environmental toxins, the practical question is the one the Anschutz researchers explicitly raised at the end of their paper: is there anything you can do to lower PFAS levels once they are in your body? There is one clinical intervention with randomized evidence behind it, and it points in a direction relevant to what we do.
What PFAS Actually Are, and Why They Persist
Per- and polyfluoroalkyl substances, almost always shortened to PFAS, are a class of roughly 15,000 synthetic compounds developed beginning in the mid-twentieth century for their resistance to heat, grease, and water. They are in nonstick cookware, waterproof and stain-resistant fabrics, firefighting foams, food packaging, cosmetics, and the water supply of most American communities.
The carbon-fluorine bond at the heart of every PFAS molecule is among the most stable in organic chemistry, which is why these compounds are called “forever chemicals.” They do not readily break down in the environment or in the body. Biological half-lives for the common long-chain variants run between two and eight years, meaning that reducing exposure alone is not a fast solution. Without an active intervention, what is already circulating stays for a long time.
The Evidence of Harm Has Moved Past Association
For years, concerns about PFAS lived mostly in epidemiological associations. That has changed.
On fertility, a 2023 Mount Sinai study published in Science of the Total Environment followed 382 women in Singapore who were trying to conceive. Women with higher combined PFAS exposure were 30 to 40 percent less likely to achieve clinical pregnancy or live birth within a year compared to those with lower exposure. The biggest single contributor to the mixture effect was PFDA.
On fetal development, the Anschutz group has now provided a molecular mechanism for the craniofacial abnormalities observed for years in higher-exposure populations. PFDA blocks an enzyme called CYP26A1 that is responsible for breaking down excess retinoic acid in the developing fetus. With that brake removed, retinoic acid levels climb, disrupting the genetic programs that shape the developing face and skull. The researchers describe “underdeveloped eyes and abnormal jaw formation” as the most common results, at exposure levels they describe as low.
Two independent research groups, one studying adults trying to conceive and one studying fetal development, have converged on the same molecule as the most concerning actor in the PFAS family. That is not how coincidences look. It is how a scientific consensus begins to form.
The broader epidemiological picture, much of it documented in the EPA’s own analyses, includes associations between long-chain PFAS and kidney cancer, testicular cancer, thyroid disease, elevated cholesterol, preeclampsia, liver disease, and impaired vaccine response in children. In 2024, the EPA concluded that PFAS can cause harm “at levels much lower than previously understood” and that essentially no level of exposure could be called safe.
Can PFAS Levels Be Reduced?
Until a few years ago, the honest answer was that no intervention had been shown in a randomized trial to lower PFAS concentrations in the blood. That changed with a 2022 paper from Macquarie University and Fire Rescue Victoria, published in JAMA Network Open. To our knowledge, it remains the only randomized controlled trial of an intervention for PFAS reduction in humans.
The design was clean. Two hundred eighty-five Australian firefighters with elevated PFOS levels were randomized to one of three arms: regular plasma donation every six weeks, whole blood donation every twelve weeks, or observation only, all for twelve months. Firefighters are a high-exposure population because of aqueous film-forming foam, which has been used for decades to fight fuel fires and is heavily laden with PFAS.
At twelve months, plasma donation reduced mean serum PFOS by 2.9 ng/mL, roughly a thirty percent drop from baseline. Blood donation reduced it by 1.1 ng/mL, a smaller but still statistically significant effect. The observation group did not change. Similar patterns held for PFHxS, another common PFAS variant. For PFOA, plasma donation produced a significant 0.5 ng/mL reduction while whole blood donation showed no significant change at all. Plasma donation was the more effective intervention by a factor of roughly three to one, and the explanation is straightforward: plasma carries a higher concentration of PFAS than whole blood, donation can be performed more frequently, and each plasma donation moves a larger volume of the fluid compartment where these molecules live.
That is the first and so far only randomized evidence that any clinical intervention can lower the burden of forever chemicals in the human body. It is also the setup for a clinical question we find ourselves asked more often every month.
Where Therapeutic Plasma Exchange Fits, and Where It Doesn’t
Therapeutic plasma exchange, or TPE, is a medical procedure performed in clinical settings by apheresis-trained physicians. It removes plasma and replaces it with fresh albumin solution. It is FDA-cleared and has been used for decades to treat more than a hundred indications established by the American Society for Apheresis. It is related mechanistically to plasma donation but is more thorough, performed under physician supervision rather than in a donor center.
The mechanistic logic is straightforward. If regular plasma donation can measurably reduce PFAS levels through a series of modest removals over twelve months, therapeutic plasma exchange, which is performed at clinical rather than donation scale and can be repeated on a clinical schedule, would be expected on first principles to produce a more pronounced reduction in circulating PFAS. A single TPE session moves more plasma than a single donation does, and our protocols are set in a clinical rather than a blood-bank context.
That expectation has not yet been tested in a randomized trial. We want to be clear about that. The firefighter study involved donation, not TPE. No clinical trial has yet examined PFAS reduction specifically with therapeutic plasma exchange. The evidence-based claim supported by the Macquarie RCT is that plasma-compartment removal lowers circulating PFAS. The extrapolation to TPE is mechanistically reasonable and, in our view, worth formal study. It is not yet proven, and we would not describe it otherwise.
The second thing we want to be clear about is this: reducing circulating PFAS does not change ongoing exposure. A patient who undergoes plasma donation or TPE and then returns to drinking from PFAS-contaminated water, cooking with nonstick cookware, eating from grease-resistant packaging, and wearing stain-treated fabrics will re-accumulate. Source reduction comes first. Any plasma-based intervention is a complement to that, not a substitute.
Who Should Consider Testing Their PFAS Levels
We do not routinely recommend PFAS testing for the general population. For certain groups, however, the question is worth raising with a physician.
Firefighters and people with occupational aqueous film-forming foam exposure. People who have lived near military bases, industrial facilities, or communities with documented PFAS-contaminated water. Women planning a pregnancy, particularly those with a history of difficulty conceiving or pregnancy complications. Patients with unexplained thyroid disease, persistently elevated cholesterol, or a personal history of kidney or testicular cancer in the context of known environmental exposure. And patients pursuing longevity medicine who want a clearer picture of their environmental toxic burden.
Commercial PFAS panels are now widely available. Interpretation requires clinical context. What matters is not any single number but the total body burden, the trajectory over time, and what clinical picture the patient is bringing to the conversation.
The Honest Clinical Conversation
Patients who have read about “blood detoxification” products being marketed for forever chemicals deserve a sober clinical conversation rather than either dismissal or upsell. What the evidence supports is this: PFAS cause measurable harm at exposure levels well below what most Americans carry, reducing exposure is the first intervention in every case, and plasma-compartment removal is the only clinically-tested method to reduce what is already circulating. Whether therapeutic plasma exchange will prove to be a more efficient version of what the firefighter study demonstrated is a question our field needs to answer, and we suspect it will be.
At Global Apheresis, we perform therapeutic plasma exchange in a clinical setting, under physician supervision, with the same standard of care we apply to every patient. If you are thinking about PFAS exposure in your own life, or if you have already tested elevated levels and are weighing options, we are happy to have the conversation.
Allen P. Green, M.D., is Board-Certified in Clinical Pathology and serves as Associate Medical Director at Global Apheresis in Mill Valley, California. He has personally performed over 500 TPE procedures and writes on plasma exchange and environmental medicine at allenpgreenmd.com.
To discuss whether therapeutic plasma exchange is appropriate for your situation, schedule a complimentary Discovery Call. Most consultations are conducted via telehealth.
References
Gasiorowski R, Forbes MK, Silver G, et al. Effect of Plasma and Blood Donations on Levels of Perfluoroalkyl and Polyfluoroalkyl Substances in Firefighters in Australia: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(4):e226257.
Cohen NJ, Yao M, Midya V, et al. Exposure to perfluoroalkyl substances and women’s fertility outcomes in a Singaporean population-based preconception cohort. Sci Total Environ. 2023.
Hvizdak M, Kandel S, Lampe JN. Perfluorodecanoic acid disrupts retinoic acid homeostasis and induces craniofacial abnormalities. ACS Chem Res Toxicol. 2026.
U.S. Environmental Protection Agency. PFAS Strategic Roadmap: EPA’s Commitments to Action. Updated 2024.
Office of the Texas Attorney General. Press Release: Attorney General Ken Paxton Launches Investigation into Lululemon Over Potential Presence of Toxic “Forever Chemicals” in Activewear. April 13, 2026.