Testosterone testing in Canada: how it is done, what is insured and what it costs

How the test is done

Testosterone follows a daily rhythm and is highest in the morning, so every Canadian source specifies the time. The BC Guidelines testosterone testing protocol, revised 27 October 2022, states the sample "must be collected in the morning, preferably before 10:00AM, or within three hours of waking up" and "preferably in a fasting state," when the sleep-wake pattern is stable and not during acute illness. The Canadian Urological Association's 2021 guideline gives a morning draw of 7 to 11 a.m. The Endocrine Society's 2018 guideline asks for a fasting morning total testosterone measured with an accurate assay, confirmed by repeating it on a separate fasting morning. LifeLabs says collection within three hours of waking is preferred; Dynacare's Ontario test page lists no preparation.

Total testosterone is the first test everywhere. Free and bioavailable testosterone are calculated from the total, SHBG and albumin, not measured directly; the BC protocol treats the two calculations as diagnostically equivalent and reserves them for men whose total is below the laboratory's lower limit when a question remains. Alberta Precision Laboratories made calculated bioavailable and free testosterone orderable province-wide from 4 April 2024 as second-line tests, and from 11 December 2025 reports them as individual components. Results should be compared within one laboratory: the BC protocol notes that two measurements on the same person can differ by up to 30 percent and that reference ranges are laboratory-dependent. Choosing Wisely Canada's endocrinology list, updated April 2026, puts it in one line: "A low level should be confirmed on a different day, again measuring the total testosterone."

Which tests are publicly insured

The dollar figures are what the province pays the laboratory, from the BC Laboratory Services Outpatient Payment Schedule revised 29 May 2026 and the Ontario Schedule of Benefits for Laboratory Services effective 1 April 2026; they are not patient charges. Quebec covers laboratory services from participating professionals through RAMQ and allows a fee of up to $15 for sample transport, but no RAMQ page naming testosterone was found. Manitoba and Saskatchewan test-level coverage could not be confirmed from a public document and is recorded as unknown. Two Ontario sources disagree on free testosterone: the schedule lists it as insured (L608) while TeleTest marks it "Not Covered by OHIP"; the schedule is used here and the conflict is shown.

What the test costs without a requisition

Several online TRT services include the first requisition in their fee or state no charge for it; what each publishes is in the costs table under requisition and laboratory testing. A requisition is the order for the test, not the test itself.

Reference ranges and units

Canadian laboratories report testosterone in nanomoles per litre. LifeLabs' Burnaby reference laboratory, 15 March 2024, gives an adult male total testosterone range of 8.4 to 28.8 nmol/L, calculated free testosterone 115 to 577 pmol/L and bioavailable testosterone 2.7 to 13.5 nmol/L; LifeLabs' 2026 Ontario patient guide prints a different free testosterone range of 179 to 475, so the range on your own report is the one that applies. Dynacare Ontario gives 5.76 to 30.43 nmol/L for men under 50 and 5.41 to 19.54 for 50 and over. Alberta gives 8.0 to 35.0 nmol/L for men 18 and over. To convert, multiply nmol/L by 28.84 for ng/dL; the Endocrine Society's harmonized lower limit of 264 ng/dL is 9.2 nmol/L. The full table of ranges and guideline thresholds is on the testosterone levels page.

Tests while on treatment

The Canadian Urological Association's 2021 guideline states that testosterone, with or without gonadotropins, should be measured to determine adherence and absorption, timed to the formulation, "mid-cycle for injectables"; that hematocrit should be followed to detect polycythemia, with dose reduction, a break, a change of formulation or phlebotomy at 55 percent or more; and that PSA testing and a digital rectal exam should follow prostate cancer screening guidelines. It recommends measuring estradiol before therapy only in men with breast symptoms or gynecomastia. The BC protocol takes hematocrit, PSA and a prostate exam at baseline, repeats them at three and six months, then yearly if stable, with total testosterone yearly once stable. The Endocrine Society's 2018 guideline asks for PSA and a prostate exam before starting and again 3 to 12 months later in men aged 55 to 69 who choose prostate monitoring, with urology referral for a PSA rise of more than 1.4 ng/mL in the first year or a confirmed PSA above 4.0 ng/mL. What each provider publishes about its own monitoring is in the providers table; what the evidence says about hematocrit by formulation is in the guides.

Common questions

What time should testosterone be tested?

In the morning. The BC testosterone testing protocol says the sample must be collected in the morning, preferably before 10 a.m. or within three hours of waking, preferably fasting. The Canadian Urological Association gives 7 to 11 a.m. The Endocrine Society asks for a fasting morning sample. LifeLabs says collection within three hours of waking is preferred.

Do I need two testosterone tests?

Guidelines ask for a low result to be confirmed. The Endocrine Society says to confirm by repeating the morning fasting measurement on a separate morning. Alberta Precision Laboratories prints on every result that a low value should be confirmed with a repeat test. The BC protocol notes that two measurements on the same person can differ by up to 30 percent and advises using the same laboratory. What testing a case needs is a decision for the doctor or nurse practitioner.

Is a testosterone test covered in Canada?

When a physician or nurse practitioner orders it, total testosterone is an insured laboratory test in British Columbia (MSP fee $15.81), Ontario (OHIP L340, $14.48) and Alberta. PSA screening is patient-pay in BC and uninsured in Ontario unless prostate cancer is suspected or diagnosed. Free or bioavailable testosterone is insured in Ontario as L608, but LifeLabs lists bioavailable testosterone as uninsured there; in BC a request for it is converted to total testosterone plus SHBG when criteria are met. Quebec, Manitoba and Saskatchewan test-level coverage could not be confirmed from a public document.

How much does a testosterone test cost without coverage?

Prices read on 8 October 2026: TeleTest quotes total testosterone at $15, free testosterone $30, SHBG $16, estradiol $27, LH or FSH $15, PSA $41 and a complete blood count $15 in Ontario, plus its own $49 consultation; LifeLabs sells a Hormone Health (Testosterone) panel for $98 in Ontario and bioavailable testosterone for $67; Dynacare Plus sells a men's testosterone home test kit for $99 with OHIP coverage or $138.99 without; Blood Tests Canada lists total testosterone at $180.25 including tax. Prices and provinces served vary by company.

What is the difference between total, free and bioavailable testosterone?

Total testosterone is everything in the blood, bound and unbound. Free testosterone is the small unbound fraction; bioavailable testosterone is free plus the part loosely bound to albumin. Canadian laboratories calculate free and bioavailable values from the measured total, SHBG and albumin rather than measuring them directly. The BC protocol treats calculated bioavailable and calculated free testosterone as diagnostically equivalent and uses them only when total testosterone is below the laboratory's lower limit and a question remains.

What tests are done while on TRT?

The Canadian Urological Association says testosterone should be measured to check adherence and absorption, mid-cycle for injections, that hematocrit should be followed to detect polycythemia, with action at 55 percent or more, and that PSA testing and a prostate exam should follow prostate cancer screening guidelines. The BC protocol repeats hematocrit, PSA and the prostate exam at three and six months after starting, then yearly if stable. Neither recommends routine estradiol monitoring.