It has been hypothesized that a wide variety of reproductive and developmental problems observed in some wildlife populations and in humans are caused by exposure to environmental contaminants that can interfere with endocrine signaling pathways (reviewed by Vos et al. 2000). This hypothesis is supported by a growing body of evidence from laboratory studies that show that pollutants present in the environment can disrupt the endocrine functioning of wildlife species, thus causing permanent alterations in the structure and function of the endocrine system [reviewed by Tyler et al. (1998)]. There are, however, significant gaps in our knowledge of endocrine disruption in wildlife and humans, particularly in the causes and mechanisms of these phenomena. Although the interaction of pollutants with endogenous hormone receptors (e.g., the estrogen receptor) continues to dominate the literature, there are many associations between exposure to endocrine-disrupting chemicals (EDCs) and a variety of biological outcomes for which the mechanisms of action are poorly understood. This makes it difficult to distinguish between direct (hormone-receptor–mediated) and indirect effects and between primary and secondary outcomes. Moreover, wildlife species are rarely exposed to single chemicals but instead are exposed to complex, fluctuating mixtures of contaminants that may act in various ways (Silva et al. 2002; Sumpter 2003; Thorpe et al. 2001, 2003) and that may induce combination effects (Rajapakse et al. 2002) via the same or different mechanisms. Wastewater treatment works (WwTW) effluent, for example, contains a mixture of natural and synthetic xenobiotics, household and agricultural chemicals, pharmaceuticals, hormones, and other compounds, many of which remain unidentified (Stevens et al. 2003). Studies have correlated exposure to WwTW effluent with alterations in sex steroid hormone levels in adult and juvenile fish (Folmar et al. 1996, 2001a; Hecker et al. 2002), impaired gonadal development in adults and juveniles (Hemming et al. 2001; Jobling et al. 2002; Sheahan et al. 2002), altered sexual differentiation in early life stages (Rodgers-Gray et al. 2001), and induction of the egg-yolk precursor protein vitellogenin (VTG) in adult male and juvenile fish of both sexes (Harries et al. 1999; Purdom et al. 1994; Rodgers-Gray et al. 2001). These effects have been associated with the presence of chemical contaminants in the effluents that act as estrogen receptor agonists, including natural and synthetic steroids (Desbrow et al. 1998; Routledge et al. 1998), alkylphenol polyethoxylates (Gimeno et al. 1997, 1998; Gronen et al. 1999; Jobling et al. 1996; Seki et al. 2003), and phthalates and pesticides (Ankley et al. 2001; Christiansen et al. 2000; Jobling et al. 1995; Sohoni and Sumpter 1998). These disorders, however, may not necessarily be a consequence of estrogenic effects alone. Many EDCs are reactive chemicals that exhibit multiple mechanisms of toxicity by acting at different sites within the body. Consequently, alterations to the endocrine immune and nervous systems and damage to genetic material may each contribute toward the overall toxic impact of a particular chemical (Choi et al. 2004; Galloway and Handy 2003; Handy 2003; Roy and Liehr 1999). It is pertinent to note that a recent comprehensive literature survey of 48 EDCs revealed that 79% of these were also carcinogenic or mutagenic, 52% were also immunotoxic, and 50% were also neurotoxic (Choi et al. 2004). Essentially half of all the chemicals tested (including both natural and synthetic) cause tissue injury at high enough doses (and thus could result in disruptions in immune function and in cancers, etc.). Both 4-tert-nonylphenol (4-NP) and bisphenol A (BPA), for example, are contaminants found at appreciable concentrations in the aquatic environment that can cause endocrine disruption by interacting with both the estrogen receptor (as agonists; Gaido et al. 1997) and the androgen receptor (Sohoni and Sumpter 1998). In addition, 4-NP can disrupt steroidogenesis in the liver and can interfere with the dynamic control of follicle-stimulating hormone release from the pituitary (Harris et al. 2001). Moreover, recent studies have also shown that concentrations of 4-NP and BPA that inhibit gonadal development and reproductive function in fish can also cause damage to the kidneys (as a consequence of VTG induction) and decreased body weight and induce stressed behavior (Magliulo et al. 2002) as well as result in damage to DNA [in barnacles, Atienzar et al. (2002)] and to the immune system [in rats, Karrow et al. (2004)]. Similarly, steroid estrogens that are known to be present in WwTW effluents (Desbrow et al. 1998) and to cause feminizing effects in fish have been reported to be genotoxic in mammals both in cell lines and in vivo (Banerjee et al. 1994; Floyd et al. 1990; Han and Liehr 1994; Nutter et al. 1991, 1994). With these issues in mind, we need a better understanding of the relative importance of the impact of endocrine disruption on the physiology of wild organisms compared with the other forms of toxicity. Furthermore, studies are also needed to help unravel how some of the health effects seen in wildlife and ascribed to endocrine disruption are actually mediated. To date, virtually nothing is known of the potential importance of interacting modes of toxicity in complex cocktails of pollutants. Several studies have documented either the immunological (Kakuta and Murachi 1997) or genotoxic (White et al. 1996) activity/effects of WwTW effluents separately, but there are no studies in which the impacts of WwTW effluents on these axes have been examined simultaneously or that have compared the relative importance and sensitivity for these disruptive/toxic effects. Our goal in this present study was to fill these knowledge gaps by examining the integrated health effects (reproductive, endocrinological, immunological, genotoxic, and nephrotoxic) of long-term (300-day) exposure to a range of concentrations of a treated WwTW effluent on the roach (Rutilus rutilus), a common European fish species in which a widespread incidence of endocrine disruption has been described and reported (Jobling et al. 1998; Nolan et al. 2001). The exposure regime adopted covered the period of embryogenesis and development during early life.