Receipt Still In the Hot Seat

In 2024, social media briefly crowned the humble receipt as a new health villain. In a viral video with over 3.3 million views, health influencer Paul Saladino warned that receipt paper contained endocrine-disrupting chemicals. His elaborate, almost hazmat approach to avoiding contact with receipts sparked both concern and ridicule. The video gained traction with the “high-testosterone alpha men” community, who are convinced that receipts contain high levels of estrogen that threaten their manliness. But it seems that sensationalism has once again misconstrued the facts.

While the thermal paper used for receipts doesn’t contain estrogen, it does contain endocrine disruptors (chemicals that disrupt the body’s hormone system, which regulates mood, reproduction, metabolism, and growth). The chemicals Bisphenol A and S (BPA and BPS) are often cited as the main culprits in receipt paper. Recent bans have led to some vendors using thermal paper that contains less BPA and BPS, but these receipts are still in the hot seat. Substitute chemicals, such as Bisphenol AF (BPAF) and TGSA, share similar structures and may carry similar health risks.

BPA and BPS exposure are associated with chronic diseases like metabolic syndrome (a group of conditions that increase the risk of heart disease, stroke, and type 2 diabetes) and certain cancer types. Bisphenol exposure also hits our wallets. A study from Poland highlighted the growing economic burden that bisphenol-associated metabolic diseases have imposed on health care systems.

If people are concerned about bisphenol exposure, opt in for e-receipts when possible and wash your hands after handling receipts.

In the U.S., BPA exposure is estimated to cause more than $2 billion in annual economic losses, while bisphenol-related metabolic syndrome costs exceed $250 billion across North America. The financial strain can be attributed to the chronic nature of bisphenol-related conditions requiring continuous, high-cost care, resulting in significant long-term insurance expenditures

Receipts made with BPAF and TGSA are currently deemed safe. However, chemical safety assessments often overlook skin absorption as an exposure route, raising questions about whether these alternatives still pose health risks. A French study analyzed how these substitutes can be absorbed through the skin. The researchers tested whether BPAF and TGSA could pass through the skin barrier under controlled lab conditions.

Similar to its bisphenol predecessors, both BPAF and TGSA (approximately one-fifth of the applied dose) can be absorbed through the skin. Absorption occurred slowly but steadily over many hours. BPAF absorption began after about 6 hours and reached a constant rate by 14 hours, while TGSA took longer, starting after 11 hours and reaching a steady absorption rate around 25 hours.

While these chemicals are absorbed through the skin, it is important to note that absorption is not instantaneous.

Despite the seemingly slow absorption rate, researchers classified both substances as “fast penetrants,” meaning they can move through the skin more easily compared to other chemicals. Notably, after the chemicals were absorbed, a large portion of each chemical stayed trapped within the skin, acting as a reservoir that could slowly leech into the body over time. Researchers estimate that 60% of the absorbed dose could eventually reach systemic circulation.

The long-term effects of these chemicals have not yet been studied, but early data suggest similar risks to BPA, including possible developmental and reproductive impacts. In the EU, BPAF is officially classified as toxic to reproduction, and both chemicals are suspected of endocrine disruption.

Concerns of potential for hazardous exposure are particularly relevant for people who regularly handle receipts, such as cashiers. Nonetheless, the risk isn’t just occupational. Bisphenols can be found in thermal labels applied to meats, seafood, cheese, or produce, and even in environmental dust.

The safety guidelines for assessing the effects of all bisphenol thermal papers need to be continually monitored and updated. While these chemicals are absorbed through the skin, it is important to note that absorption is not instantaneous. As Dr. Rubin suggests, if people are concerned about bisphenol exposure, opt in for e-receipts when possible and wash your hands after handling receipts.