Understanding the in-sewer stability of chemical biomarkers is crucial for effective wastewater-based epidemiology (WBE) studying. Sewer conditions, including environmental and biological factors, significantly influence biomarker transformations. This study investigated the stability of chloroxylenol (PCMX) under different levels of pH, temperature, shear force, and ventilation status, and then clarified the fate and behavior of PCMX in gravity sewers (GS). Results indicated the stability of PCMX obviously increased with higher pH and shear force, and lower temperature in both well- and partially-ventilated GS reactors. In poorly-ventilated GS reactors, the highest degradation rates occurred under normal conditions (pH = 7.0, T = 20 °C, shear = 1.15 N/m2). Biological activity (MPR>SPR) and dissolved oxygen (DO) primarily drove PCMX transformation, with minimal effects from pH, temperature, and shear force. A positive correlation existed between PCMX transformation and DO, and a negative correlation existed between PCMX transformation and biological activity. Mass balance analysis indicated that adsorption and bioaccumulation dominated PCMX transformation in GS, while biotransformation occurred with the increasing of DO and prolongation of HRT. Additionally, the suitability of PCMX as a WBE biomarker under different GS conditions was assessed. PCMX was viable as a biomarker in partially-ventilated GS under pH 8 or shears force of 0.48 N/m2 conditions, and in poorly-ventilated GS under pH 6 or shears force of 0.48 N/m2 conditions. This study enhances understanding of factors affecting PCMX stability and supports its application as a WBE biomarker in community health assessments.