This study examined the physical and physiological demands and perceived experience of a multicomponent exercise mode, recreational team handball (TH), for middle-aged/elderly men and women, played as same- vs. mixed-gender 6v6 game formats. Matches’ heart rate (HR), blood lactate (BL), perceived experience, activity profile, player load and accelerometer variables were assessed. Forty-one participants, with at least 12 weeks of experience with recreational TH (22 men; 69±4 years, 19 women; 66±6 years), performed 2 same- and 2 mixed-gender matches on an indoor 40x20 m TH court. A game format-by-gender interaction was observed for mean HR (%HRmax), time spent ˃80 and ˃90%HRmax, respiratory rating of perceived exertion and for several of the external load variables (p≤0.05). During mixed-gender matches, time spent ˃80 and ˃90%HRmax, was higher for women vs. men (p≤0.017). During same- and mixed-gender matches, BL was lower for women than men (p≤0.015). Time spent ˃90%HRmaxwas lower for women (p =0.036), whereas time spent ˃80%HRmaxwas higher for men during same- vs. mixed-gender matches (p =0.034). The frequency, %total match time and distance covered with high-demanding movements were higher for men during same-gender than during mixed-gender matches (p≤0.036), and higher for men vs. women in same- and mixed-gender matches (p≤0.046). The frequency of high-intensity actions, accelerations, time spent in the higher player load zones and total accumulated player load, were higher for men vs. women during same- and mixed-gender matches (p≤0.044). Fun levels were very high (9.1–9.3 AU, 0–10). Mixed-gender small-sided recreational TH games are physiologically more demanding for middle-aged/elderly women compared to men. Men showed higher cardiovascular and activity profile demands when playing same-gender matches, which was opposite to women. Nevertheless, TH is a high-intensity and motivating exercise mode for both genders, regardless the gender game format, meaning that exercise interventions may use same- and mixed-gender matches to promote participants’ health.