OHIP Coverage for Hormone Testing: What Ontario Women Need to Know
Navigating hormone testing coverage in Ontario can be confusing. Many women wonder whether their hormone tests will be covered by OHIP (Ontario Health Insurance Plan) or if they'll need to pay out of pocket. Understanding your options can help you make informed decisions about your health and budget accordingly.
Which Hormone Tests Are Covered by OHIP in Ontario?
In Ontario, there are many hormone tests that can be covered by OHIP if they are ordered by your Medical Doctors. However, anything that's ordered by a Naturopath is not covered by OHIP.
OHIP lists all covered tests in a PDF document (updated as of February 2025). These fees are different from those of Naturopaths. From what I've seen in my practice, when doctors order comprehensive hormone panels, usually there's only one or two tests that are not covered by OHIP, but everything else generally is covered.
Common hormone tests that can be OHIP-covered include:
LH, FSH
Estrogen and progesterone
Testosterone
Androstenedione
TSH, free T4, free T3, thyroid antibodies
Cortisol
DHEA
Prolactin
The Challenge with Comprehensive Testing
With our healthcare system, it's very textbook picture. Unless you have all the classic signs and symptoms, certain tests may not be ordered. For example, if someone doesn't have any joint pain, fatigue, or the classic signs and symptoms of autoimmune diseases, they may not consider it. Or if someone has regular periods, PCOS may not be explored because it’s not a classic presentation.
However, sometimes these tests are really important. I've seen cases where patients didn't have classic symptoms, but when we tested based on their history and research, the results came back abnormal, providing more insight into their symptoms. It wasn’t just in their head.
Can My Family Doctor Order Comprehensive Hormone Testing?
Yes, your family doctor can order comprehensive hormone testing.
The initial assessment will help me understand which tests may be necessary to help understand the patient’s concerns. After assessing what tests are needed based on a thorough history intake, I can write a letter to the patient's doctor outlining which tests we'd like to explore. The patient then follows up with their doctor to discuss their options.
What Hormone Tests Are NOT Covered by OHIP?
One test that's particularly important but not covered by OHIP is Sex Hormone Binding Globulin (SHBG).
Because SHBG is not part of the diagnostic criteria for PCOS, it’s often not included in the workup despite the research showing that it is typically low in women with PCOS.
Are There Any Age Restrictions for OHIP-Covered Hormone Tests?
The answer is yes and no; it depends on the situation.
Testing in Younger Women
At puberty, it can take several years for women’s hormones to balance out, so it may not be beneficial to test them even if patients are experiencing symptoms like irregular cycles or acne.
However, if symptoms are pretty severe or there's something else going on, we could consider testing. For example, I had a patient who had PMDD (premenstrual dysphoric disorder), where she had suicidal ideations before her period. In that case, we tested for her, and it came back showing that her stress and male hormones were elevated. When we treated that, her low mood subsided, and her symptoms became more manageable during her cycle.
Testing Across Life Stages
The test also changes depending on the symptoms or their stage in life. Hormones that we test during a woman's reproductive years may be different or change during menopause, where we wouldn't test certain things because it wouldn't make sense during that time if they don't have a period.
So yeah, it just changes with where they're at in their life.
Understanding the Timing of Hormone Testing
One important consideration that's often overlooked: depending on where you are in your cycle or period, it's important to time out the blood work, too. In some cases like in PCOS, peri-menopause or menopause, we don't have to time it out, but oftentimes I get patients who come to me saying their progesterone is too high or too low, that they're not making any at all.
When we take a step back and track where they're at in their cycle, it actually makes total sense. There's absolutely nothing wrong with the results.
Birth Control and Testing
I also get patients who are on birth control, and they test their hormones. Birth control can suppress hormones like estrogen and progesterone, so when they test, it's going to come back low. Thus, it doesn't actually make sense to test when they're on birth control. But then I have patients who come to see me, saying there's something going on, and it's not showing up on anything. Again, it's completely normal; the fact that they were on birth control pills just wasn't looked into before they got the blood work done.
Different types of birth control pills also have different effects on the body. For example, there are birth control pills that have anti-androgen properties (it decreases male hormones in the body) or have what we call a high androgen index (it can increase male hormones in the body). The type of birth control pill that a patient is on should also be considered if hormone testing is done.
Are There Alternative Ways to Access Hormone Testing in Ontario?
If you can't get testing through your family doctor via OHIP, there are alternatives:
Working with a Naturopath
If you have extended healthcare benefits, a health spending account, or insurance, tests ordered by a naturopath may be covered under those benefits rather than being completely out of pocket.
The Reality of Our Healthcare System
I have many patients who are not happy with their Medical Doctors. However, doctors have their own healthcare guidelines that they must also consider. Some of our policies are outdated and do not support women’s health.
Our healthcare system also does not consider risk management, there's no prevention, there's no proactive care. It’s a very reactive system of care. Sometimes you just have to go outside of the box a little to get the comprehensive testing you need.
Making Informed Decisions About Your Hormone Health
The key is understanding that comprehensive hormone testing is important for getting answers about what's going on with your health. These are the missing pieces of information that patients are looking for. It’s not just in their head. It’s not just stress.
Every Medical Doctor’s and every Naturopath’s approach can be different. Knowing what's potentially covered by OHIP and what alternatives exist can help you advocate for the care you need. Whether through your family doctor or alternative coverage options, comprehensive hormone testing can provide the biomarkers we need to fully understand your health.
Ready to get answers about your hormone health? Book a consultation with Dr. Kathy Nguyen to discuss your symptoms and create a personalized treatment plan.