Objective To investigate the relationship of benign prostatic hyperplasia(BPH) with abnormal glucose and lipid metabolism in the elderly. Methods A total of 152 elderly patients with BPH were selected as study subjects. The levels of fasting plasma glucose (FPG), 2-hour postprandial glucose (2 hPG), fasting insulin (FINS), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), blood uric acid (UA), and prostate-specific antigen (PSA) were measured. Their systolic blood pressure (SBP) and diastolic blood pressure (DBP) were also measured. Prostate volume (PV) and annual prostate growth rate were calculated, and the International Prostate Symptom Score (IPSS) was assessed. Based on blood glucose, blood lipids, and IPSS, the patients were divided into normal blood glucose group(99 cases) and hyperglycemia group(53 cases), normal blood lipid group(112 cases) and dyslipidemia group(40 cases), and moderate symptom group(91 cases) and severe symptom group(61 cases). The clinical characteristics of patients in each group were compared, and the relationships of abnormal glucose and lipid metabolism with the severity of lower urinary tract symptoms in patients with BPH were analyzed. Results Compared with the normal blood glucose group, patients in the hyperglycemia group had higher age, SBP, annual prostate growth rate, IPSS, and levels of FPG, 2 hPG, FINS, and PSA, larger PV, and lower HDL-C level (P < 0.05). Compared with the normal blood lipid group, patients with BPH in the dyslipidemia group had higher age, SBP, annual prostate growth rate, IPSS, and levels of FPG, FINS, TC, TG, LDL-C, and UA, larger waist circumference and PV, and lower HDL-C level (P < 0.05). Compared with the moderate symptom group, patients in the severe symptom group had higher age, BMI, SBP, annual prostate growth rate, and FPG levels, higher incidence rates of hyperglycemia and dyslipidemia, larger PV, and lower HDL-C levels (P < 0.05). Multivariate Logistic regression analysis indicated that age ≥70 years, SBP ≥140 mmHg, hyperglycemia, dyslipidemia, increased PV, and elevated annual prostate growth rate were all independent risk factors for the occurrence of severe lower urinary tract symptoms in patients with BPH (P < 0.05). Conclusion Elderly BPH is closely related to abnormal glucose and lipid metabolism, and abnormal glucose and lipid metabolism are risk factors for the exacerbation of lower urinary tract symptoms.