Developed by a multidisciplinary expert team organized by the Urology Committee of Beijing Association of the Integrating of Traditional and Western Medicine, these guidelines aim to address the clinical challenges in pharmacotherapy arising from the increasing prevalence of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) in elderly males against the backdrop of China's aging population. Based on systematic reviews, randomized controlled trials, cohort studies, and clinical practice experience, the guidelines employed a graded evidence evaluation system (levels A, B, C) and adopted the Delphi method to form expert consensus, thus ensuring the validity and independence of the recommendations. The literature reviews comprehensively covered major Chinese and English databases, focusing on pharmacotherapy studies for BPH/LUTS in men aged ≥65 years. The guidelines systematically elaborated on the clinical application of eight major drug categories, including α_1-blockers,5α-reductase inhibitors, plant-based preparations, muscarinic receptor antagonists, β3-adrenergic receptor agonists, phosphodiesterase type 5 inhibitor, desmopressin, drug combination therapy, and traditional Chinese medicine (TCM) based on syndrome differentiation. It also specifically analyzed the risks associated with multimorbidity and polypharmacy in elderly patients. The guideline put forward seven core recommendations:① Conduct a comprehensive assessment of comorbidities and medications to prevent drug-drug interactions.② The α_1-blockers are recommended as first-line therapy, with caution required for orthostatic hypotension.③ The 5α-reductase inhibitors are suitable for patients with enlarged prostate volume.④ Muscarinic receptor antagonists or β3-agonists may be considered for patients with concomitant overactive bladder (OAB).⑤ Tadalafil can be considered for patients with erectile dysfunction, but it is contraindicated with nitrates. ⑥ Desmopressin can be used for significant nocturia, with monitoring required for hyponatremia.⑦ TCM treatment should follow syndrome differentiation principles, and monitoring of liver and kidney function is necessary.