Question about Avatar Module

Like many here, I have had lots of trouble with the Avatar module.   This is probably a dumb question, but what happens when you don't install it?  Do the profile pictures get made into thumbnails?

When you don't install it, members have either the default male or female thumbnail, depending on their selected gender.

So how are most people handling this.   I am finding members who have joined who have several avatars, but no profile picture.  Shouldn't the "profile photo" function on the join form end up being - well you know, the profile photo?   What are people doing to make this work here?

I am mostly looking for "best practices" here.  Are other people losing the profile pic on loading the avatar - or losing both when the avatar fails?    How do you get people to put their profile pictures in?   This is extremely frustrating - almost as if the product was designed to not work in the real word.