Objective:To investigate the distribution and clinical characteristics of traditional Chinese medicine (TCM) syndromes of male infertility (MI) (oligospermia and asthenospermia) among the middle-aged and elderly in Shanghai. MethodsA total of 434 middle-aged and senile MI patients in Shanghai were selected for the investigation of the distribution of TCM syndromes. The clinical symptoms were evaluated by PADAM scale, and the serum total testosterone (TT) level was tested and semen routine test was conducted.  Results:①The majority of 434 patients were aged from 35 to 45 years old, up to 91.24%. Among all the identified TCM syndromes, kidney essence deficiency syndrome accounted for the highest proportion (31.11%), followed by downward flow of damp-heat syndrome, spleen-kidney yang deficiency syndrome, other syndromes, qi stagnation and blood stasis syndrome, and dual deficiency of qi and blood syndrome. There was a difference of TCM syndrome distribution between patients with hypoandrogenism and the overall patients (P<0.05). Patients with hypoandrogenism accounted for 28.57% of all patients, and kidney essence deficiency syndrome was the most common. ②Among the main TCM syndromes, ISS scores (physical fitness symptoms, vasomotor symptoms and sexual function symptoms) of spleen-kidney yang deficiency syndrome were significantly higher than those of kidney essence deficiency syndrome and downward flow of damp-heat syndrome (P<0.05), total sperm vitality of spleen-kidney yang deficiency syndrome was also significantly lower than that of kidney essence deficiency syndrome and downward flow of damp-heat syndrome (P<0.05), and TT level was significantly lower than that of downward flow of damp-heat syndrome (P<0.05). ③Among the two main TCM syndromes with the highest proportion in non-hypoandrogenism patients, the hypoandrogenism group and non-hypoandrogenism group of spleen-kidney yang deficiency had more serious physical and sexual symptoms (P<0.05), less severe vasomotor symptoms (P<0.05), and significantly weaker total sperm vitality (P<0.05) than those shown in the kidney essence deficiency group with the same androgen level. ④In the kidney essence deficiency group, only vasomotor symptoms were different between the two groups with different androgen levels (P<0.05), while other clinical features did not show significant statistical differences (P>0.05). However, the hypoandrogenism group of the spleen-kidney yang deficiency showed more serious physical symptoms, sexual function symptoms and sperm vitality damage (P<0.05).  Conclusion:TCM syndromes of MI (oligospermia and asthenospermia) of the middle-aged and senile patients in Shanghai are mainly identified as kidney essence deficiency syndrome, downward flow of damp-heat syndrome and spleen-kidney yang deficiency type. Intervention should be strengthened for vasoconstriction symptoms of patients with kidney essence deficiency syndrome, while improvement in physical symptoms and sexual function should be considered for patients with spleen-kidney yang deficiency syndrome. In addition, the corresponding specific symptoms of TCM syndromes may be more serious for patients with hypoandrogenemia, which must be paid attention to clinically, especially for patients with spleen-kidney yang deficiency syndrome.