17-hydroxyprogesterone (17-OHP)

Pick Ordered or Not ordered to see the note.

Indicated when

• —Hirsutism, acne, or irregular cycles suggesting hyperandrogenism, where 17-OH progesterone is checked to exclude non-classic congenital adrenal hyperplasia as part of the differential before attributing the picture to PCOS [1, 2]

Not indicated when

• —Included in a routine hormone panel with no hirsutism, acne, or menstrual irregularity present

Why not

Non-classic congenital adrenal hyperplasia is an uncommon cause of hyperandrogenism, and a level drawn outside the recommended morning, follicular-phase window can be misleadingly high, which can prompt an ACTH stimulation test that would not otherwise have been needed (evidence gap: the diurnal/cycle-phase variation itself is well-established physiology not independently sourced this session; see evidence_notes).

Better first step

Assess cycle history and hyperandrogenism features first, and order a morning 17-OH progesterone alongside TSH and prolactin only as part of a structured PCOS or hirsutism work-up, rather than as a stand-alone screening test [1, 2].

Typical ND rationale

An ND may order 17-OH progesterone alongside androgen testing for a patient with hirsutism, acne, or irregular cycles, reasoning that a treatable adrenal cause of the same picture should be ruled out before attributing it to PCOS alone.

Ontario coverage & CONO orderability

OHIP status

insured

17-OH progesterone is listed by name (L333) in the 2026 Schedule of Benefits for Laboratory Services, insured when a physician who has clinically assessed the patient orders a blood sample. The Schedule addresses only the blood specimen; OHIP does not fund saliva hormone testing through community labs, so a saliva 17-OH progesterone (the format some NDs order) is uninsured regardless of who orders it. The same blood test ordered by an ND is patient-paid regardless (Reg. 552 s.22).

CONO orderable

Yes — CONO list #1, #169

CONO list item 1, blood: '17-OH-Progesterone.' CONO list item 169, saliva: '17-OH-Progesterone.'

Linked conditions

• pcos ↗

Counselling script

“If you have excess hair growth, acne, or irregular cycles that raise the possibility of a rare adrenal condition that can mimic PCOS, a morning 17-hydroxyprogesterone test is the right way to check for it, timed to the early follicular phase if your cycles allow, and I'll order it today. Without those features, this isn't part of routine hormone screening, so I won't order it today. If your androgen picture is otherwise unexplained, we can revisit it.”

Revisit if

• —New or worsening hirsutism or acne
• —New menstrual irregularity
• —Androgen excess remains unexplained after initial work-up

References

1. [1]International PCOS Network (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. link17-OH progesterone is one of the tests used to exclude non-classic congenital adrenal hyperplasia before diagnosing PCOS
2. [2]Endocrine Society (2018). Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. linkThe Endocrine Society hirsutism guideline recommends testing for elevated androgen levels in women with an abnormal hirsutism score, the context in which 17-OH progesterone is used to exclude non-classic CAH
3. [3]Endocrine Society (2018). Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. linkThe current Endocrine Society clinical practice guideline for congenital adrenal hyperplasia due to 21-hydroxylase deficiency, for which 17-OH progesterone is the standard diagnostic test
4. [4]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026) - L333 17-OH progesterone. link17-OH progesterone (L333) is listed by name in the 2026 OHIP Schedule of Benefits for Laboratory Services
5. [5]Government of Ontario (e-Laws) (2026). Health Insurance Act, R.R.O. 1990, Reg. 552: General, s. 22 (insured laboratory services). linkA lab test is insured only when ordered by a physician, midwife, or NP who has clinically assessed the patient
6. [6]Ontario Ministry of Health (2026). Ontario Health Insurance Plan: Schedule of Benefits for Laboratory Services (effective April 1, 2026). linkTests ordered by anyone other than an authorized provider, including NDs, are not insured services