Alexa Fleckenstein M.D.

You must have heard about my adorable tomcat Otto. He is all black, with two small white spots, on his breast and on his belly. Every time he sees me, he throws himself on his back, begging for a belly rub. When I first got him from the shelter, his fear to be touched by a stranger was greater than his desire to get a belly rub. But over time, he became bolder, and now I can touch his belly most of the time, and indeed, he even demands it. So, when I do my chore and rub his belly, invariably I am astonished to find that he has nipples, two nice rows of it. What a waste to put nipples on a male! In a female, the nipples would serve to feed the young. But in a male? In the Creation story, God takes a rib from the sleeping Adam and shapes Eve out of it. So why did Adam have nipples? He shouldn’t! I don’t want to offend religious feelings, but nipples prove that Evolution is real, and that Darwin was right. For me, nipples are the neatest evidence for the Earth and all her inhabitants having come a long way. In fetal development, the first fourteen weeks are exactly the same in male and female. After that, under influence of the male hormone testosterone, a boy and his special parts develops. If testosterone is not supplied (as in a genetic girl), the fetus stays what it was, basically, and becomes a girl. And since having or not having nipples is of minor consequence, evolution never selected against nipples; they just stayed where they were left at week fourteen of embryonic development. Medically, the male breast occasionally can develop cancer – just like the female breast does. But the number is only one in a hundred male cases to female cases. Anyway, an unusual swelling in a man’s breast should be evaluated by a physician. However, swelling of both male breasts usually stems from the influence of hormones (or hormone-like substances). It is called gynecomastia, meaning: breasts like females. They can be a sign that testosterone levels are too low in a man, or that estrogens are too high. In any case, they should also be seen by a physician. This condition often happens in puberty, when the balance of hormones is not yet perfect, and most often it vanishes on its own. In older men, development of breasts may have to do with obesity and/or alcohol consumption: When the liver is too busy with alcohol, it cannot break down estrogens very well – those estrogens are also produce normally in men, although in low numbers. But when the liver is failing, the estrogen level rises relative to testosterone levels, and gynecomastia develops. Time to drink less alcohol (or none)! The liver has a great capacity for regeneration – and half a year alcohol-free does wonders (if there wasn’t already cirrhosis, the end-stage of liver disease). All these musings just from stroking Otto’s belly – amazing. But even more amazing is Evolution, I guess. Read More