ABs are clinically effective and well-tolerated by patients with LUTS/BPH.152 However, there are differences in side effects between agents which may lead to worsening in quality of life or withdrawal of the agent. Therefore, it is important to engage in shared decision-making, taking into account patient preference and comorbidities when selecting an AB. Specifically, younger men concerned about sexual function or fertility should be counseled regarding the possibility of ejaculatory dysfunction (EjD) and that alfuzosin is likely the first choice for these men. In older men or those with cardiac risk factors, silodosin would likely be the first choice because they are probably less concerned about ejaculation, and silodosin has a decreased risk of orthostatic hypotension.  The most common reported side effects were dizziness/orthostatic hypotension, and the most common sexual side effect was EjD.116, 146-148, 153 Abnormal ejaculation was reported to be 3-10% for patients on tamsulosin and silodosin compared to 0% for those on alfuzosin, suggesting that alfuzosin is the agent of choice for patients concerned about EjD.147 Abnormal ejaculation may be due to classic retrograde ejaculation, or a decrease or absence in seminal fluid.154 Other side effects were inconsistently reported but one RCT reported lower rates of dizziness with silodosin (33%) compared to alfuzosin (43%), and another reported lower rates of orthostatic hypotension with silodosin (0%) compared to alfuzosin (3.4%).146, 147 There were no comparative trials between tamsulosin and alfuzosin or silodosin that reported side effects within this Guideline’s systematic review, but prior studies have shown that alfuzosin had lower rates of EjD compared to tamsulosin and silodosin.154 In addition, the known higher selectivity towards the alpha-1A receptor likely plays a role in lower hypotensive effects of silodosin and tamsulosin compared to alfuzosin.155 The non-uroselective ABs, doxazosin and terazosin, also have higher rates of orthostatic hypotension compared to the uroselective agents due to decreased selectivity towards the alpha-1A receptors. Finally, ABs should be used with caution in patients with severe renal or hepatic impairment due to the metabolism and clearance pathway of these agents, and interactions with other pre-existing medications should be considered.