Objective To study the association between serum testosterone level and insulin resistance (IR) in elderly male hypertensive patients.Methods One hundred and seven elderly male hypertensive patients were divided into IR group (n=44) and IR-free group (n=63).Their total TST level was measured,their FAI and TSI were assayed.The patients were further divided into TST≥14 nmol/L group (n=72) and TST＜14 nmol/L group (n=35).The association between serum testosterone level and IR in elderly male hypertensive patients was analyzed.Results The serum TST level,FAI and TSI were significantly lower in IR group than in IR-free group (12.02±2.66 nmol/L vs 15.98±3.98 nmol/L;20.16％±2.75％ vs 28.53％±4.74％;2.26±0.49 nmol/U vs 3.21±0.55 nmol/U,27.67％±5.49％ vs 25.98％±4.98％;2.95±0.39 nmol/U vs 2.78±0.64 nmol/U,P＜0.05).The FAI and TSI were significantly higher in hypertention grade 1 patients than in hypertension grade 3 patients (P＜0.05).The IR was significantly lower while the serum TST level,FAI and TSI were significantly higher in TST≥14 nmol/L group than in TST＜14 nmol/L group (33.3％ vs 57.1％,P=0.019;18.43±3.41 nmol/L vs 12.15±2.23 nmol/L,P=0.002;32.49％±5.67％ vs 24.57％±6.94％,P=0.036;3.53±0.87 nmol/U vs 2.55±0.62 nmol/U,P=0.016).TST,FAI and TSI were negatively associated with HOMA-IR (r=-0.406,r=-0.469,r=-0.429,P=0.000).Conclusion Low serum TST level is a risk factor for IRin elderly male hypertensive patients.