Glomerular filtration rate usually decreases with advancing age as a result of structural and functional changes in the aging kidney, but women are substantially protected against the age-dependent decline in renal function. This sexual dimorphism is the product of differences in chromosomes, perinatal programming and gonadal hormones (sex steroids) that create sexual phenotype. In this Review, Chris Baylis focuses on the role of the sex steroids, with a particular emphasis on the effects of sex and age on the nitric oxide system.