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Lower urinary tract symptoms have a multifactorial etiology, are common in men and increase with age. In view of the unprecedented growth of the aging population worldwide and in the United States, an increase in the number of men with lower urinary tract symptoms is expected in the near future. In contrast, a decline in the number of practicing urologists is projected. Many men do not discuss their lower urinary tract symptoms with health care practitioners or seek treatment. Thus, they remain undiagnosed, untreated or both. For such men, self-treatment with over-the-counter alpha blockers with proven efficacy and safety is an unsubstantiated option. However, use of over-the-counter alpha blockers for the treatment of lower urinary tract symptoms is controversial owing to the multifactorial nature of these symptoms and concerns associated with over-the-counter use of alpha blockers.This review summarizes a debate held at the 2015 Annual Meeting of the American Urological Association (May 15–19, 2015, New Orleans, Louisiana) on whether over-the-counter alpha blockers are in the best interest of patients.Concerns about over-the-counter use of alpha blockers for the treatment of lower urinary tract symptoms, including inappropriate self-diagnosis and/or self-treatment by patients; potential for missing an important disease; and failure to adhere with guidelines on the assessment of lower urinary tract symptoms are reviewed, as are corresponding rebuttals supporting use of over-the-counter alpha blockers for the treatment of lower urinary tract symptoms.Over-the-counter alpha blockers are not yet available. Ongoing studies will determine whether appropriate safety and usage criteria can be achieved.