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The medication that is most commonly prescribed to help alleviate erectile dysfunction and low sperm count in males with end-stage renal disease (ESRD) is sildenafil. Sildenafil is a phosphodiesterase type 5 (PDE5) inhibitor that specifically works by increasing blood flow to the penis, thus helping to achieve and maintain an erection. Additionally, testosterone replacement therapy may help to improve testosterone levels, which can positively influence sperm production; however, its primary use is not specifically targeted at erectile dysfunction.

Epoetin alfa is primarily used to treat anemia in patients with kidney disease by stimulating the production of red blood cells, and it does not directly address sexual function issues. Furosemide is a diuretic used to manage fluid overload and hypertension in patients with renal failure but is not related to the treatment of erectile dysfunction or sperm count issues.

Therefore, sildenafil is the most appropriate choice for addressing both erectile dysfunction and low sperm count in this context.