AbstractBeijing is undergoing multiple challenges including urbanization, warming and aging. The Beijing megalopolis of 20 million people now suffers more cold‐related than heat‐related deaths. Stratospheric aerosol injection (SAI) geoengineering is designed to lower surface temperatures, so if SAI were ever done, it may reduce future heat‐related mortality, while also increasing cold‐related mortality. Here we use four Earth System Models (ESM) downscaled to 10 km resolution with the Weather Research and Forecasting (WRF) system to capture urban temperature, humidity and wind speeds. Temperature‐related mortality risk were calculated using a distributed lag nonlinear model (DLNM) of the elderly (over 65s) under the dynamically downscaled moderate (RCP4.5) and extreme (RCP8.5) greenhouse gas, and the G4 SAI scenarios. We used population demographics for all five shared socioeconomic pathways (SSP) and various adaptation measures. Heat‐related excess deaths under G4 are 630∼3,160 per year fewer than RCP4.5, while cold‐related deaths are 370∼1,990 more than RCP4.5 during 2060–2069, with a marginally significant net reduction. G4 significantly reduces the excess deaths relative to RCP8.5. Both heat‐related and cold‐related mortality will increase by 240∼490% when the aging population is accounted for, and decrease by 11%, 23% and 44% under low, medium and high adaptation relative to a no adaptation scenario. Dynamical downscaling produces better quality climate simulations than commonly used statistical approaches, and in the case of Beijing, significantly fewer heat‐related deaths. The marginal health benefits of modest future SAI in Beijing may be representative of the population impacts in the extra‐tropics where deaths due to cold are more than those caused by heat.