Is TRT covered by OHIP?

Ontario treats testosterone replacement therapy (TRT) as three separate things: the visits, which OHIP insures; the laboratory tests, most of which OHIP insures; and the drug, which OHIP never pays for. This page sets out each part with the fee or price the province publishes and the date it was read.

Visits: covered when medically necessary

The province's OHIP page, updated 22 April 2026, states that OHIP covers the full cost of services as long as they are medically necessary, including virtual visits delivered by video or telephone. It lists prescription drugs provided in non-hospital settings, and services delivered through secure messaging or any means other than video or telephone, as not covered.

Under the virtual care funding framework in effect since 1 December 2022, a video or phone visit with a physician who has an existing relationship with the patient is a comprehensive virtual care service; one with a physician who has never treated the patient is a limited virtual care service, billed at a lower fee. A relationship is established by an insured in-person service in the preceding 24 months, among other routes. Comprehensive phone visits are paid at 85 percent of the equivalent in-person assessment. Whether a particular online TRT service bills OHIP for its visits, charges its own fee, or both, is for that service to state; the providers table records what each one publishes.

Blood tests: most are insured, PSA screening is not

The Schedule of Benefits for Laboratory Services dated 10 March 2026, effective 1 April 2026, lists these tests with no insured-condition restriction attached: total testosterone (L340, $14.48), free testosterone (L608, $14.48), LH (L328, $4.71), FSH (L315, $4.61), prolactin (L332, $4.11), estradiol (L310, $7.08) and a complete blood count (L393, $3.98), which includes hematocrit and hemoglobin. The dollar figure is what OHIP pays the laboratory, not a charge to the patient.

Prostate-specific antigen (PSA, L354 and L358, $9.50 each) is insured only for men diagnosed with, treated for or followed after prostate cancer, or where the practitioner suspects prostate cancer from history, race or physical examination. Routine screening is uninsured: the practitioner marks the requisition uninsured and the patient pays the laboratory. The requisition wording was revised on 16 April 2026 without a change to insured status. Whether a PSA ordered before or during testosterone therapy fits the suspected or diagnosed categories is a clinician's decision; the schedule does not address it.

Bioavailable testosterone does not appear in the schedule. LifeLabs states that bioavailable testosterone is an uninsured test in Ontario and lists it at $67. What each test measures, when it is drawn and what it costs to pay for privately is on the testosterone testing page.

The medication: Ontario Drug Benefit, Limited Use code 397

The ODB formulary, version 2.17, lists these testosterone products as Limited Use benefits, with the drug benefit price per unit as read on 8 October 2026:

Every listed product carries reason-for-use code 397: "For male patients with confirmed low morning serum testosterone levels associated with documented, symptomatic hypothalamic, pituitary or testicular disease, or in HIV-infected patients." The formulary note adds that older men with non-specific symptoms of fatigue, malaise or depression who have a low-normal random testosterone level do not satisfy the criteria. The authorization period is one year. A prescriber writes the code on the prescription; there is no separate application.

For an ODB-eligible patient who does not meet the Limited Use criteria, the Exceptional Access Program is the route the province names for formulary drugs outside their Limited Use conditions; only an Ontario physician or nurse practitioner can apply (ontario.ca, updated 5 October 2026). Rainbow Health Ontario's FAQ, posted August 2025, states that injectable and gel testosterone for gender-affirming care are covered through an Exceptional Access form for ODB-eligible patients; that is the organization's statement, not a government page.

The pharmacy adds a mark-up on the drug benefit price (8.5 percent under $100 since 1 April 2024) and a dispensing fee. What those come to at the counter, and what a cash-paying patient is quoted, is on the testosterone prices at the pharmacy page.

Who the Ontario Drug Benefit covers

• Age 65 and over: automatic from the month after the 65th birthday. The first $100 of prescription costs each program year (1 August to 31 July) is paid by the senior, then up to $6.11 per prescription. Members of the Seniors Co-Payment Program pay no deductible and up to $2.
• Age 24 and under (OHIP+): covered when the person has OHIP and no private plan; ends on the 25th birthday.
• Ontario Works, ODSP, long-term care and home care recipients.
• Trillium Drug Program: any Ontario resident with OHIP whose plan does not cover 100 percent of drug costs. The deductible is about 4 percent of after-tax household income, paid in four quarterly amounts, then up to $2 per prescription.

Adults between 25 and 64 with no ODB entitlement pay the pharmacy price or use a private plan. The same facts for the other nine provinces are on the drug plan coverage page, and the Ontario care pathway is on the TRT in Ontario guide.

Common questions

Is TRT covered by OHIP?

In parts. OHIP pays for medically necessary visits to a physician or nurse practitioner, in person or by video or telephone, and for most of the laboratory tests used to diagnose and monitor low testosterone. OHIP does not pay for prescription drugs outside hospital. Testosterone is paid for only by the Ontario Drug Benefit program, for people the program covers and who meet its Limited Use criteria, or by private insurance.

Is testosterone free in Ontario?

Not for most adults between 25 and 64. The Ontario Drug Benefit covers testosterone products as Limited Use benefits for people it insures: everyone 65 and over, people 24 and under with no private plan (OHIP+), Ontario Works and ODSP recipients, people in long-term care or receiving home care, and Trillium Drug Program enrollees once their deductible is met. Seniors pay the first $100 each program year and then up to $6.11 per prescription; Trillium members pay a deductible of about 4 percent of after-tax household income, then up to $2 per prescription (ontario.ca, pages updated 18 August and 11 February 2026).

Which testosterone products does the Ontario Drug Benefit cover?

As Limited Use benefits with a drug benefit price per unit, read 8 October 2026: Taro-Testosterone Cypionate 100 mg/mL 10 mL vial $34.88; Testosterone Enanthate 200 mg/mL 5 mL vial (Hikma) $35.59; AndroGel 1 percent 2.5 g $2.55 and 5 g $4.51; Taro-Testosterone Gel 1 percent 2.5 g $1.67 and 5 g $2.96; Testim 1 percent 5 g $4.40; Taro-Testosterone 40 mg capsule $0.56. Depo-Testosterone, Delatestryl and Andriol are shown as not a benefit. Natesto and Jatenzo did not appear in the formulary search.

What is Limited Use code 397?

The reason-for-use condition that every testosterone product on the Ontario Drug Benefit formulary carries. Its wording is: "For male patients with confirmed low morning serum testosterone levels associated with documented, symptomatic hypothalamic, pituitary or testicular disease, or in HIV-infected patients." The formulary adds that older men with non-specific symptoms such as fatigue, malaise or depression who have a low-normal random testosterone level do not satisfy these criteria. The authorization period is one year.

Are testosterone blood tests covered by OHIP?

The Ontario Schedule of Benefits for Laboratory Services, effective 1 April 2026, lists total testosterone (L340, $14.48), free testosterone (L608, $14.48), LH, FSH, prolactin, estradiol and a complete blood count with no condition attached. PSA is insured only for men diagnosed with or followed for prostate cancer, or whose practitioner suspects prostate cancer; routine screening is uninsured and the patient pays. Bioavailable testosterone does not appear in the schedule, and LifeLabs states it is an uninsured test in Ontario.

Does OHIP cover online TRT clinics?

OHIP covers medically necessary virtual visits delivered by video or telephone by an OHIP physician. Under the virtual care framework in effect since 1 December 2022, a video or phone visit with a physician who has no existing relationship with the patient is billed as a limited virtual care service at a lower fee, and services delivered by secure messaging alone are not insured. Membership, program or consultation fees charged by a private clinic are charges from the clinic, not OHIP services; whether a given clinic also bills OHIP for the visit is a question for that clinic.