Purpose of Review <p>To examine current evidence on the relationship between testosterone and lower urinary tract symptoms (LUTS) in men, focusing on endocrine, metabolic, and inflammatory mechanisms and their implications for clinical practice.</p> Recent Findings <p>Recent studies demonstrate that testosterone influences bladder, prostate, and pelvic floor function through androgen-receptor pathways. Low testosterone amplifies inflammation, oxidative stress, and vascular dysfunction, while metabolic syndrome with associated hypogonadism and sleep disorders exacerbate LUTS severity. Experimental and clinical data confirm that physiologic testosterone therapy does not worsen LUTS or prostate outcomes when appropriately monitored.</p> Summary <p> Testosterone deficiency contributes to LUTS through systemic, not purely anatomical, mechanisms. Restoring physiologic hormone balance and addressing metabolic and sleep factors improves urinary function and quality of life. Future research should prioritise phenotype-specific trials and integrated metabolic-endocrine-urological approaches to refine personalised care for men with LUTS and hypogonadism.</p>