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Tobacco use in the United States continues to be the leading cause of preventable deaths, disease, and disabilities, with nearly forty million adults smoking cigarettes in our nation [1]

Pipe Tobacco: Often taxed differently (sometimes at lower rates), which has led some manufacturers to label cigarette blends as pipe tobacco to reduce costs

Turk et al., 2011

Existing literature has depicted that smoking initiation for the majority of people happens at a young age, and the transition to regular smoking happens between adolescence and young adulthood [55]

Moreover, another study 33 has speculated whether cigarette smoke and cotinine may act as aromatase inhibitors and reduce the conversion of testosterone to estradiol, thereby contributing to elevated testosterone levels