TNF and orchitis: Others found that fluorine can also cause orchitis [15] and pro-inflammatory cytokine production, such as tumor necrosis factor-alpha (TNF-α), transforming growth factor-beta 3 (i.e., TGF-β3), and interleukin (IL)-1a, by Sertoli cell and germ cells, impairing spermatogenic cell development and differentiation [16].