Urethral stricture disease is one of the oldest described urologic pathologies and urethroplasty is associated with high success rates. Many urethral strictures are thought to arise from iatrogenic injury or radiation therapy which can create ischemic insults to the urethra. In developed countries, most urethral strictures are idiopathic; therefore, much is still unknown about the etiology and pathogenesis of this disease. Testosterone is known to mediate vasculogenesis through vascular endothelial growth factor (VEGF) and hypoxia inducible factor-1α (HIF-1α) pathways in various organs. Recently, testosterone has been shown to mediate urethral vasculogenesis. In the setting of testosterone deficiency, androgen supplementation can improve urethral vascularity. Further, there appears to be a high incidence of testosterone deficiency in men with urethral strictures. Despite many advances in our understanding of testosterone's association with the urethra over the past few years, there remains much to be learned about the mechanism of testosterone on urethral stricture etiology and whether testosterone deficiency and supplementation impact urethral reconstruction outcomes.