The aquatic environment is an important site for perfluorooctanoic acid (PFOA) deposit. Nevertheless, the exact mode of action and its resulting toxicological effects in aquatic organisms remain largely unknown. To gain a better understanding of the mode of action of teleost PFOA toxicity, transcriptomics, proteomics, biochemical parameters and reproduction were integrated in this study. Male and female zebrafish were exposed to nominal concentrations of 0.1, 0.5 and 1 mg L(-1) PFOA for 4 and 28 d resulting in PFOA accumulation which was higher in males than in females. These gender-related differences were likely caused by different elimination rates due to distinct hormone levels and differences in transport activity by solute carriers. The general mode of action of PFOA was described as an increase of the mitochondrial membrane permeability followed by an impairment of aerobic ATP production. Depletion of liver glycogen stores together with altered expression levels of transcripts involved in carbohydrate metabolism, with emphasis on anaerobic metabolism, was probably a means of compensating for this decreased aerobic efficiency. The mitochondrial dysfunction further resulted in effects on oxidative stress and apoptosis at the gene transcript and protein level. As a consequence, evidence for the replacement of the affected cells and organelles to sustain tissue homeostasis was found at the transcript level, resulting in an even greater glycogen depletion. Despite this increase in metabolic expenditure, no effects on reproduction were found indicating that the fish seemed to cope with exposure to the tested concentrations of PFOA during the exposure period of 1 month.