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It may also alter your sleep architecture, which can indirectly lower testosterone levels

Some observational studies suggest that patients with NAFLD who continue using tobacco products may have higher rates of advanced fibrosis compared to non-users with similar metabolic profiles, though the strength of evidence specific to smokeless tobacco remains uncertain

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For women, it disrupts menstrual cycles and increases the risk of pregnancy complications

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Vaga S, Lee S, Ji B, Andreasson A, Talley NJ, Agreus L, et al