The effect of sterilization on bacterial endotoxin is an area of increasing interest for medical devices due to the growing popularity of transferring devices from one sterilization modality to another, and the focus on end-to-end microbiological quality. This review documents the effects of sterilization on bacterial endotoxin, with attention drawn to industry regulations to show how such regulations are aligned (or not) with published data. In summary, numerous experiments have shown a dose-dependent reduction in pyrogenicity and/or LAL reactivity of endotoxin following sterilization, in contrast to a number of publications and industry standards that claim – without evidence – that sterilization does not mitigate endotoxin. The results of this review would be useful for device manufacturers when selecting a sterilization modality or deciding whether to test for endotoxin pre- vs post-sterilization, as well as standards developers for future alignment of regulations with published data.