Physically, the middle-aged experience a decline in muscular strength, reaction time, sensory keenness, and cardiac output. Also, women experience menopause at an average age of 48.8 and a sharp drop in the hormone estrogen. Men experience an equivalent endocrine system event to menopause. Andropause in males is a hormone fluctuation with physical and psychological effects that can be similar to those seen in menopausal females. As men age lowered testosterone levels can contribute to mood swings and a decline in sperm count. Sexual responsiveness can also be affected, including delays in erection and longer periods of penile stimulation required to achieve ejaculation.