The impact of ageing on the human cardiovascular system has been the subject of several studies in recent years, but with insufficient emphasis on defining sex-specific differences. To rectify this, gender-specific differences in structure and function in the human cardiovascular system were studied in a European population during natural ageing.Cardiac power output (CPO) was measured and integrated with changes in left ventricular (LV) mass, diastolic, systolic and limb blood flow, blood pressure and exercise capacity in 93 health-screened men and 122 women, aged 20 to 75 years.Correlating with a 21% loss of LV mass, maximum cardiac pumping (i.e. CPO max = Q̇ max x MAP max ) and reserve (CR = CPO max −CPO rest ) capacities decreased 20–25% with age in male hearts. In contrast, CPO max , CR and LV mass were all preserved in ageing women. Maximum cardiac output (Q̇ max ; 26–32%), peak forearm blood flow (FBF peak ; 61%) and exercise capacity (40–50%) all decreased, but more so in men than women. In contrast, systemic vascular resistance (68–75%) and mean arterial pressure (MAP max ; 14–26%) increased in both sexes.CPO rest decreased 27% in men, but was unchanged in women, despite lower early:late diastolic filling (48–51%), Q̇ rest (19–23%) and FBF rest (56%) in both sexes.Understanding sex-specific differences in cardiovascular ageing is important for public health and biomedical research, given increasingly larger older populations and the need to prevent and treat cardiovascular disease.