Extracellular vesicles (EVs) serve as crucial mediators of intercellular communication in spermatogenesis, steroidogenesis, and age-related pathophysiological processes within the male reproductive system. These EVs exhibit promising prospects for disease diagnosis and therapeutic administration. This review explores the impact of advanced paternal age on male fertility and testosterone decline, shedding light on the underlying mechanisms. It highlights the decline in semen quality, DNA damage, and alterations in sperm miRNA profiles associated with aging. The interplay between oxidative stress and antioxidants crucially regulates male reproductive aging. Currently, most studies focus on Sertoli cell-derived EVs, while understanding of Leydig cell-derived vesicles remains limited. Multi-omics integration will enhance the understanding of male reproductive aging and guide personalized interventions, revealing potential biomarkers and targets in the future.