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INTRODUCTION: Alpha-1 adrenergic receptor antagonists (α1-ARAs) are used in the well-established treatment for benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS). Since BPH and erectile dysfunction (ED) are commonly concomitant conditions, the importance of addressing the potential role of α1-ARA in patients with ED is rising. METHODS: We systemically reviewed literature for studies that assessed erectile function (EF) indices in relation to α1-ARA use. All types of comparisons were included. RESULTS: Out of 1915 records, 21 articles have been included. All the articles suffered high risk of bias. α1-ARA showed a significant improvement in EF in comparison to baseline and placebo. Some α1-ARA are more erectogenic than others. Combined therapy with phosphodiesterase-5 inhibitors improved EF better than either alone. Factors like associated lower urinary symptoms, dose, and duration of therapy modify α1-ARA effects on EF. CONCLUSION: Αlpha1-ARAs have a potential role in improving EF in subjective and objective scales. However, the available evidence is extracted from studies on patients with other indications for α1-ARAs, particularly BPH-related LUTS. Further investigations should target patients with ED only to precisely identify their clinical utility.