Imposex is the superimposition of non-functional male sex organs in gastropod females. This syndrome is a hormonal imbalance induced by tributyltin (TBT) which have been used in antifouling paints formulation. The present study aimed to perform an integrated environmental assessment of imposex and butyltin (BT) contamination using surface sediments and tissues of Thaisella chocolata (an edible gastropod) from northern Chile. The results showed imposex incidence in 11 out of 12 sites. In the most contaminated sites, which are areas under the influence of maritime activities, and also used for fishing and aquaculture, RPLI were over 60 and VDSI over 4 (high incidence of sterile females). Exceptionally high contamination levels and evidences of fresh inputs of tributyltin (TBT) were detected along the studied area. TBT levels above 300 and 90 ng Sn g− 1, respectively, were recorded in sediments and edible gastropod tissues of 6 sites. Thus, a daily ingestion of 90 to 173 g of T. chocolata foot (4 to 8 organisms) from the most contaminated sites will certainly lead to the consumption of BT exceeding the tolerable daily intake recommended by European Food Safety Authority. It is reasonable to consider that human risk is even higher if daily consumption of additional seafood is considered. Moreover, some contaminated sites were located within the marine reserve “Isla Grande Atacama”, indicating that even marine protected areas are under the influence of TBT contamination. These findings suggest that current levels of TBT in the studied area are sufficient to induce harmful effects on the environment and constitutes a potential threat to seafood consumers. Thus, national regulatory actions toward environmental protection and food safety of local populations are still mandatory, even after 8 years of the TBT global ban by IMO.