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European Society of Endocrinology

ESE

The European Society of Endocrinology is at the centre of Europe's endocrine community.

Lobbying Activity

Response to EU’s next long-term budget (MFF) – EU funding for competitiveness

12 Nov 2025

The European Society of Endocrinology (ESE) urges the European Commission to stand up for the value of health research In the next European MFF and the Research Framework Programme. ESE joins the call of the Biomedical Alliance for Europe Strong health funding in MFF is essential for the wellbeing of EU citizens. underlining health research as a strategic investment for Europes growth and competitivenes. Due to the unique nature of the health domain, and the importance of investing in health for patient care and the wider economy, we call for the creation of a standalone health window within the European Competitiveness Fund (ECF) and Horizon Europe. The health budget must be ringfenced to enable strategic planning and enhance resilience with the option to increase it in case of emerging health threats. The European Commission should look beyond competitiveness in its health policies and funding for unmet medical needs, and enhancing the safety and availability of health innovations must be pursued. Horizon Europe is unique in facilitating cross-border research. Any links with the proposed ECF must be clarified, and the next Framework Programme must maintain its unique character and its support for a broad range of priorities, going beyond enhancing competitiveness (prevention, unmet medical needs, equal access, treatment optimisation, repurposing, regulatory science, academic trials). This needs to include strong support for EU civil society to ensure a variety of views are considered in policy making. These principles are directly applicable to the needs in endocrine health. Endocrine diseases represent some of the most prevalent health challenges, with profound impacts on morbidity and mortality, quality of life, healthcare systems, and economic productivity. 6 out of 10 adults and 1 out of 3 children live with overweight or obesity, a major contributor to cardiovascular disease, cancer, and mortality; 60 million Europeans suffer from diabetes; 1 out of 6 will face problems with fertility; each year more than 57 000 new cases of thyroid cancer are diagnosed, primarily affecting young women. More than 440 rare diseases are of endocrine origin, presenting a huge individual and societal burden. The increasing prevalence and chronic nature of these diseases adds to the burden, consuming an increasing part of the healthcare budgets. To curb the pandemic scale of endocrine-related diseases, research and innovation are essential to develop new approaches in prevention, diagnosis, treatment, and long-term follow-up. The European Society of Endocrinology (ESE) and the European Society of Paediatric Endocrinology (ESPE) have published EndoCompass Directions for the Future of Endocrine Science (https://academic.oup.com/ejendo/issue/193/Supplement_2). Authored by 228 researchers representing 28 European countries this roadmap identifies areas of research, thatwhen appropriately fundedwill contribute to a healthier Europe. This roadmap will require increased funding, a fair balance between policy-directed research (top-down) and investigator-driven research (bottom-up), and more funding for basic research alongside impact driven research. Inclusion of European Reference Networks (ERNs) in the ECF is vital for health competitiveness and rare disease care. ERNs are central to EUs health strategy for the estimated 30 million patients with rare and complex diseases. The omission of explicit mention of ERNs or rare diseases in the ECF proposal is a critical oversight. We urge the Commission to explicitly include and fund ERNs, as they are a unique, essential infrastructure that boosts competitiveness (by advancing innovative health technologies, research and biotech), strengthens health systems by ensuring equitable access to highly specialized care across borders, and ensures cohesion by integration into national healthcare systems so that specialized knowledge benefits all citizens.
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Response to Revision of EU legislation on hazard classification, labelling and packaging of chemicals

30 Mar 2023

The European Society of Endocrinology (ESE) welcomes the current legislative proposal which will contribute towards creating a non-toxic and safe EU environment as laid out in the Chemical Strategy for Sustainability. ESE has continuously pointed to the growing importance of appropriate legislation and guidance on classifying and identifying Endocrine Disrupting Chemicals (EDCs) within the European and wider international community. Being able to label and classify EDCs as such is an important first step towards a phaseout that will protect human health and the environment. Strict regulation of EDCs is pivotal to address the many adverse health outcomes associated or linked with exposure to EDCs including altered reproductive function in men and women, abnormalities in sex organs, endometriosis, early puberty, altered nervous system development and function, immune function disorders, cancers, neuroendocrine tumours, respiratory problems, diabetes, obesity, cardiovascular conditions, neurological issues and learning disabilities. These effects have been described extensively in peer reviewed literature. We are pleased to see that the current proposal establishes legally binding hazard identification of EDCs by adding hazard classes. Clear classification makes it easier to restrict EDCs once the criteria are met. Adding a category 2 of suspected endocrine disruptors will enable the classification of substances for which there is substantial evidence to be categorised as a known or assumed EDC and exempts only those substances where evidence conclusively demonstrates that adverse effects are not relevant to humans. This will provide workers and the general public with crucial information for their health and safety and improve supply chain transparency. We also support the fact that a chemical will be regarded as fulfilling the toxicity criterion (T) in any of the cases where it satisfies the requirements for being classified as an EDC. ESE further applauds hazard classes and criteria for the classification, labelling and packaging of substances and mixtures. The surmised administrative burden from revisiting the criteria of classification should not distract from the efforts put towards ensuring a high level of protection for human health and the environment. We invite policy makers to keep relying on experience and increased peer reviewed scientific knowledge, as there is decisive evidence showing that EDCs pose a significant concern for human and animal health as well as our general environment. However, to make the implementation of CLP a success, an ambitious new REACH proposal is needed in line with the latest available scientific findings. Both legislative files have strong links to endocrinology with CLP setting clear classification criteria for EDCs and REACH, as an umbrella for all chemicals legislation, regulating their restriction. Both are crucial for the future of EDCs in Europe. ESE will continue to support the Commissions goal to create a more resilient EU society and as such is available to provide more detailed scientific input where requested in a formal or more informal manner.
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Response to Proposal for Regulation to parliament and Council establishing interim instrument for MFA + to Ukraine

11 Jan 2023

The European Society of Endocrinology (ESE), the Ukrainian Diabetology Association and the Ukrainian Society of Endocrinology and Metabolism welcome the opportunity to comment on the support to Ukraine proposal for a regulation establishing an instrument for 2023 (macro-financial assistance+). The health care sector in Ukraine has been severely impacted by the war. Especially in areas where fighting continues health care infrastructures have been damaged, are suffering power supply limitations, have a shortage of qualified staff and suffer from medical equipment and drug shortages, despite the efforts by the Ukrainian Government and the international community. This affects acute care but also the care of chronic conditions. The area of endocrinology and metabolism is highly relevant to overall population health. Diseases like diabetes, thyroid disorders, obesity, fertility affect large groups of the population, and rare conditions like adrenal insufficiency, pituitary disorders and endocrine cancers demand a large individual toll. The delayed diagnosis and treatment of these chronic conditions will have a long term impact on the care to be provided. Accurate diagnosis and care of these diseases depends on a performing laboratory infrastructure, pathology services, imaging equipment, endocrine surgery and skilled and multi-disciplinary staff. Our societies therefore call for the proposed financial instrument to provide sufficient emphasis on (re-) building a healthcare system that addresses the needs endocrine patients and physicians are facing. The following should be considered by the EU and/or Ukrainian Government: Re-build and upgrade the hospital and laboratory infrastructures, with specific focus on the integration of laboratory, imaging, surgery and pathology functions, and the equipment of the intensive care units. This is highly relevant to the Eastern part of Ukraine in oblasts Kharkiv, Dnepropetrovsk, Zaporozhye, Chernihiv, Sumy, but also in Kyiv and Kyiv region, and other parts of Ukraine. Developing mechanisms to the return of qualified staff to those regions most in need Re-build the academic/non-academic infrastructure to train health care staff Specific efforts need to be paid to the multidisciplinary approach of patients in war-zone areas: depression, anxiety and uncertainty may aggravate their health condition. The provision of sufficient psychological support is critical. In diabetes care, the screening of micro and macro-vascular complications that is delayed due to the war, screening for depression and psychological disturbances and the support needed to address this are a high priority. Most endocrine conditions are chronic in nature. The uninterrupted supply of medication is critical. This relates to insulin, oral antihyperglycemic drugs, levo-thyroxine, hydrocortisone, desmopressin but also medication to treat rare diseases and endocrine cancer. Critical endocrine drugs like hydrocortisone and desmopressin should be included in the WHO emergency supply kits. The access to the European Reference Networks for diagnosis and care of rare diseases needs to be facilitated and the proposed instrument should support physicians working in Ukraine and the institutions participating in the ERNs. In parallel to the funding mechanism, European Governments must remain vigilant in monitoring the health of Ukrainian refugees and offer the available services more pro-actively to ensure all refugees receive the medical assistance they need. ESE, the Ukrainian Diabetology Association and the Ukrainian Society for Endocrinology and Metabolism will continue their efforts in supporting Ukrainian patients and physicians and offer their expertise, resources and network if requested. Only together we can overcome the monumental public health challenge that Ukraine and its people are facing. Contact ESE: D De Rijdt, Director Strategic Partnerships: dirk.de-rijdt@ese-hormones.org
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Response to Introducing new hazard classes–CLP revision

18 Oct 2022

The European Society of Endocrinology (ESE) welcomes the ambition of the Commission to create a non-toxic and safe EU environment as laid out in the Chemical Strategy for Sustainability. ESE has continuously pointed to the growing importance of appropriate legislation and guidance on classifying and identifying Endocrine Disrupting Chemicals (EDCs) within the European and wider international community. Being able to label and classify EDCs as such is an important first step towards a phaseout that will protect human health and the environment. Strict regulation of EDCs is pivotal to address the many adverse health outcomes associated or linked with exposure to EDCs including altered reproductive function in men and women, abnormalities in sex organs, endometriosis, early puberty, altered nervous system development and function, immune function disorders, cancers, neuroendocrine tumours, respiratory problems, diabetes, obesity, cardiovascular conditions, neurological issues and learning disabilities. These effects have been described extensively in peer reviewed literature. We are pleased to see that the current proposal establishes legally binding hazard identification of EDCs by adding hazard classes. Clear classification makes it easier to restrict EDCs once the criteria are met. Adding a “category 2” of suspected endocrine disruptors will enable the classification of substances for which there is substantial evidence to be categorised as a known or assumed EDC and exempts only those substances where evidence conclusively demonstrates that adverse effects are not relevant to humans. This will provide workers and the general public with crucial information for their health and safety and improve supply chain transparency. We also support the fact that a chemical will be regarded as fulfilling the toxicity criterion (T) in any of the cases where it satisfies the requirements for being classified as an EDC. ESE further applauds hazard classes and criteria for the classification, labelling and packaging of substances and mixtures. We only have a few suggested changes that may be considered:  3.11.1.1 (a): The definition presented here does not align with the WHO definition. To ensure consistency we suggest to change the text to “‘endocrine disruptor’ means a substance or a mixture that alters the functioning of the endocrine system …”  3.11.1.1 (f): this should be reworded to better reflect that a correlation between a chemical and the endocrine system can also be theoretical. The sentence “where the correlation is consistent with existing knowledge” can be deleted.  Table 3.11.1: For category I and category II, in the sentence “an adverse effect in an intact organism or its offspring and future generations”, “and” should be replaced with “and/or”.  Table 3.11.2: In our view there is no safe threshold for exposure to EDCs and hence we recommended that for category I not to allow any concentration of an EDC as a component of a mixture The surmised administrative burden from revisiting the criteria of classification should not distract from the efforts put towards ensuring a high level of protection for human health and the environment. We invite policy makers to keep relying on experience and increased peer reviewed scientific knowledge, as there is decisive evidence showing that EDCs pose a significant concern for human and animal health as well as our general environment. ESE will continue to support the Commission’s goal to create a more resilient EU society and as such is available to provide more detailed scientific input where requested in a formal or more informal manner.
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Response to Revision of EU legislation on hazard classification, labelling and packaging of chemicals

1 Jun 2021

The European Society of Endocrinology (ESE), on behalf of more than 20,000 endocrinologists in Europe as well as the millions of patients with endocrine diseases whom it represents, welcomes the ambitious agenda of the European Commission (EC) to address the impact of Endocrine Disrupting Chemicals (EDCs). There are multiple adverse health outcomes associated or linked with exposure to EDCs, suspected to lead to diseases such as altered reproductive function in men and women, abnormalities in sex organs, endometriosis, early puberty, altered nervous system development and function, immune function disorders, cancers, neuroendocrine tumours, respiratory problems, diabetes, obesity, cardiovascular conditions, neurological issues and learning disabilities. ESE would like to raise the following points: 1) It is of the utmost importance that the many Impact Assessments conducted will not further delay the implementation of urgently needed measures such as legally binding hazard identification of EDCs, the inclusion of EDCs as a category of substances of very high concern (SVHCs), the phase-out of EDCs in consumer products, and the implementation of risk assessment factors for mixtures. 2) Suspected EDCs should be labelled as hazardous and their usage should be limited or restricted, in line with the precautionary principle, until a proper independent peer reviewed scientific assessment has taken place and/or a less harmful substitute has been identified. 3) Although the EC has acknowledged the existence of the ‘cocktail effect’, aggregated exposure of humans and wildlife to one or different EDCs in its Communication “towards a comprehensive EU framework on endocrine disruptors”, current policies do not address this aspect. 4) Definitions, criteria for identification data and testing requirements for EDCs widely diverge in EU legislation, which has led to numerous legislative loopholes. For example, the criteria under the Plant Protection Products and the Biocidal Products Regulations do not yet serve to fully capture all substances that could cause potential harm and do not align in their data requirements to identify a substance as being an EDC. They are only ‘very similar’, which already creates a fundamental issue provoking confusion, conflicts and lack of practicability and credibility. This is strengthened by the fact that the information requirements within the two regulatory frameworks diverge, leading to different levels of confidence in the identification. 5) Recent studies show that ‘certain underlying conditions associated with exposures to EDCs are exacerbating the effects of COVID-19 in vulnerable populations’. Scientists have found statistically significant endocrine pathways that may be dysregulated by EDCs that are also linked to COVID-19 severity. 6) Economic analysis reveals that EDCs cost the EU28 between €157 and €270 billion per year in healthcare expenses and lost earning potential, which equates to up to 2% of European GDP. 2 Large contributors to these figures were shown to be neurodevelopmental and metabolic disorders as well as cancer. EDC-driven obesity and diabetes alone cost between €18–€29 billion per year in the EU28.
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Response to Chemicals strategy for sustainability

20 Jun 2020

The European Society of Endocrinology (ESE), together with its 54 national and 13 specialist societies, aims to lift standards of care in endocrinology across Europe. ESE’s vision is to shape the future of endocrinology to improve science, knowledge and health. At the EU level, ESE has focused its activities mainly around Endocrine Disrupting Chemicals (EDCs). These efforts, including this response, are led by the ESE EDC Working Group chaired by Prof Josef Köhrle, affiliated to the Charité University in Berlin. EDCs are still widely prevalent in the EU and disproportionately affect vulnerable populations. EDCs have been associated with a variety of rare cancers (especially in children), impaired reproduction, osteoporosis, thyroid disease, metabolic illnesses (e.g. diabetes, hypertension and obesity), birth defects and numerous other health conditions. ESE therefore welcomes the ambition of the Commission to create a non-toxic and safe EU environment. The COVID-19 pandemic has demonstrated achieving a non-toxic environment is needed more than ever. There is increasing evidence that people with endocrine disorders such as obesity and diabetes are particularly vulnerable to COVID-19 and other viruses. Addressing EDCs could also contribute to economic recovery. Economic analysis by the Endocrine Society reveals that EDCs cost the EU27+UK between €157 and €270 billion per year in healthcare expenses and lost earning potential. That is up to 2% of European GDP . Large contributors are neurodevelopmental and metabolic disorders as well as cancer. ESE supports the Commission’s goal to build a more resilient EU society. Our shared objective is to mitigate the future impact of pandemics and endemics, likely to become more frequent. For this, creating a healthier environment with reduced exposure to EDCs is key. In other words, creation of a non-toxic, healthier environment should be viewed as a preventive measure against pandemics/endemics. There is an urgent need for consistent definitions, criteria and identification data requirements for EDCs across all EU legislation. Existing inconsistencies in EU legislation have led to numerous legislative loopholes. The REACH regulation urgently needs clear criteria and guidance on how to identify EDCs. Data requirements should also be identical under pesticide/biocides legislations. They are only ‘very similar’ which creates a fundamental issue, provoking confusion, conflicts and a lack of practicability and credibility. We also support the effort to have substances reviewed by one agency. ESE urges the Commission to develop new guidelines for the burden of proof required for an EDC to be classified as such. Currently the level of evidence required for EDC identification as laid out in the ECHA/EFSA/JRC guidance document (2018) is unrealistic. It was only possible to meet the evidence requirements for BPA because of the abundance of available information on this substance. It is highly unlikely to be possible for many other substances. We encourage the Commission to truly commit to the precautionary principle by adjusting the burden of proof in line with its application of the principle during the coronavirus and other public health emergencies (e.g. SARS, avian flu, mad cow disease). A coordinated funding effort is needed to stimulate independent research in the area of EDCs. This is a prerequisite in order to obtain impartial insights into the impact of EDCs on the population and to ensure additional scrutiny of widely prevalent chemicals in everyday products and the environment. ESE stands ready to support the Commission in its endeavour to reduce EDCs in the EU environment. Through its access to Europe’s leading experts, ESE is in a unique position to provide independent scientific advice on a wide range of EDC related topics and contribute to better understanding and therefore better regulation.
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Response to Europe’s Beating Cancer Plan

3 Mar 2020

There are four significant ways in which the endocrine system relates to cancer 1. 40% of all cancers are associated with overweight and obesity: endometrial, postmenopausal breast and colorectal cancer – all related to the endocrine system – account for over 60% of all cancers attributed to obesity. 2. EDCs have an effect on different hormones and affect both the development of obesity and cancer [1]. 3. Certain endocrine cancers are on the rise, e.g. thyroid (> 50 000 new cases/year) and neuro-endocrine tumours (>100 000 cases). 4. The endocrine system is vulnerable to aggressive anti-cancer treatments that result in endocrine co-morbidities in cancer survivors. We encourage the EC to take into account the endocrine system in all facets of the Beating Cancer plan, as the endocrine system influences and is influenced by cancer prevention, treatment and post-treatment care. The link between EDCs and cancer is studied a.o. for breast [2] and testicular cancer [3] More research needs to be funded, a strong legislative framework be put in place to avoid pesticides, biocides or consumer products containing suspected EDCs to be further used [4] and public awareness campaigns around practical ways to reduce exposure to EDCs in everyday life are needed. In endocrine cancers, ESE calls for more (financial) support to fully understand the epidemiology and clinical data. This applies a.o. to thyroid and rare endocrine cancers, that have been understudied and under-invested, as demonstrated by the low number of viable treatment options and late diagnosis at an advanced stage. Structures like EURACAN and Endo-ERN, that include specific rare cancers, need to be given the necessary resources to contribute to developing clinical guidelines and educational curricula. An ongoing and multidisciplinary approach towards cancer survivors is needed. Endocrine sequelae of cancer therapy include endocrine alterations of different glands, as well as bone, obesity and metabolic complications. Recently introduced cancer immunotherapies are a common cause of endocrine auto-immunities. Following irradiation, endocrine organs like the thyroid are at risk for subsequent malignancies. More incentives and drivers need to be created to secure healthy and affordable food to prevent obesity. This needs to start with pregnant mothers, childhood and continued into adult life. National and Community based action plans to secure lower calorie intake and reduction of sugar consumption have proven their benefit. Early detection and diagnosis of endocrine cancers, often presenting in children and young adults needs to be improved. ERN’s are the structure to address this and they will secure that the information obtained is turned into broadly supported clinical guidelines. Effective treatment and care in rare disease cancers also needs innovation. The expansion of existing therapies towards these rare cancers needs to build on quality evidence gathering in the context of international collaboration [5]. In addition to consulting cancer expert groups, ESE encourages the Commission to consult extensively with expert groups beyond the focus area of cancer alone. As outlined, endocrinology relates to cancer not only because of the existence of endocrine cancers, but also with regard to obesity, environmental factors such as EDCs, and the reactions of the endocrine system to cancer treatment. ESE can provide technical expertise on a wide range of topics that contribute to a better understanding of cancer and therefore better regulation. [1] Jeffrys et al, Int J of Cancer 2004, vol 112, p348-351 [2] Rodgers et al, Environmental Research 160 (2018):152-182) [3] Skakkebaek et al Physiol Rev 2016 (55-97) [4] Nature Reviews Jan 2020: Consensus on the key characteristics of Endocrine Disruptors as a basis for hazard identification [5] Several structures exist already that, if better supported, provide the platform to do this (e.g. ENETS, ENS@T, Endo-ERN)
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Meeting with Daniel Calleja Crespo (Director-General Environment)

18 Feb 2020 · EU strategy on endocrine disruptors

Response to Fitness Check on endocrine disruptors

9 Jul 2019

Please find in attachment the comments by the European Society of Endocrinology.
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