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Conclusions Despite the lack of solid evidence from interventional studies, which are for the most part not feasible in humans, it is clear that smoking, alcohol use and recreational drug consumption are somehow able to impair male fertility, with possible synergistic, rather than addictive, effects

Easily accessible counseling can be introduced in universities, educational programs and workshops can be conducted to raise awareness about depression and substances use

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Commercial e-liquids offer a variety of nicotine concentrations, ranging from 3, 6, 12, 18, or 36 mg/ml