Hypothalamic neural stem cells (htNSCs) are a type of glial-like neural stem cell located in the hypothalamus, possessing unique biological characteristics. They not only have the capacity to proliferate and differentiate but can also migrate into the parenchymal regions of the hypothalamus, further developing into neurons and successfully integrating into neural circuits. HtNSCs play multiple key physiological roles in the adult hypothalamus, including contributing to the formation of the blood-hypothalamic barrier (BHB), which is crucial for maintaining the stability of the hypothalamic environment. Through the BHB, htNSCs facilitate the effective diffusion of small molecules between the blood, cerebrospinal fluid, and hypothalamic parenchyma, thereby ensuring the proper transmission of nutrients and signaling molecules. In addition, htNSCs can sense fluctuations in blood glucose levels and regulate the release of neuropeptides accordingly, thus influencing the body’s energy metabolism and endocrine balance. However, as the body ages, the function of htNSCs gradually declines. Studies have shown that the aging of htNSCs has significant adverse effects on energy metabolism, sex hormone secretion, and overall hypothalamic function. During the aging process, the proliferative and differentiative capacities of htNSCs diminish, leading to reduced neuronal replenishment and subsequently impairing the hypothalamus’s ability to regulate energy balance. Furthermore, aging htNSCs may secrete inflammatory factors that disrupt the endocrine functions of the hypothalamus, thereby affecting sex hormone secretion. This impact extends beyond the hypothalamus itself and may exert widespread effects on the entire endocrine system through pathways such as the hypothalamic-pituitary-gonadal axis. Fortunately, research has found that transplanting young htNSCs can effectively alleviate neurological and skeletal muscle dysfunction associated with aging. This transplantation therapy replenishes active htNSCs, restoring normal hypothalamic function and thereby improving the body’s energy metabolism and neuromuscular function. These findings offer new perspectives and potential therapeutic strategies for anti-aging interventions. In recent years, the role of htNSCs in regulating energy metabolism and promoting aging has attracted significant attention from researchers. Studies have shown that the aging of htNSCs is closely linked to the development of various diseases. For instance, in obesity and metabolic syndrome, htNSC dysfunction may lead to disturbances in energy metabolism. Moreover, the aging of htNSCs has also been associated with the onset of neurodegenerative diseases. Therefore, in-depth research into the mechanisms underlying htNSC aging is crucial for understanding the pathogenesis of these conditions. This article briefly reviews the classification of htNSCs, the impacts of their aging on bodily functions, their relationship with related diseases, and the regulatory mechanisms that promote htNSC regeneration. Some strategies aimed at promoting htNSC regeneration and counteracting their aging appear to influence the overall aging phenotype of organisms. For example, studies have shown that modulating specific signaling pathways or gene expression can promote htNSC regeneration, thereby delaying the aging process. Additionally, certain natural products or pharmacological agents may also influence htNSC aging. Further research on htNSC aging will enhance our understanding of the hypothalamus’s role in systemic aging and elucidate the reasons behind gender differences in aging patterns. Moreover, these studies may offer novel approaches and therapeutic targets for improving energy metabolism disorders and treating diseases associated with gonadal hormone abnormalities. In summary, htNSCs play a vital role in the physiological functions of the hypothalamus and the aging process. Further investigation into the mechanisms and regulatory pathways of htNSC aging will aid in the development of new anti-aging therapies and provide innovative strategies for the treatment of related diseases.