This profound reduction in ovarian functions has substantial physiological consequences. Including accelerated loss of bone mass, and osteoporosis, hot flushes with accompanying sleep and behavior changes, vaginal atrophy, and loss of fertility. In contrast to women, fertility in men persists unt il a very old age and they experience a gradual and incomplete loss of testicular function. A significant number do experience psychological and social difficulties at some point in middle age.
Sexual impotence is considered to be the main symptom of the male climacteric.
Although sexual dysfunction increases with advancing age, partly because of drug interactions, there is no sound basis for assuming an endocrine basis for the male climactic. Men experience a more gradual and incomplete loss of testicular function with increasing age. Androgen replacement for men remain controversial.