Background: Male adolescents underutilize youth health centers' (YHC) services despite facing a variety of significant health issues. The purpose of our study was to explore adolescent males' perceptions of health service needs, utilization of YHC services, and barriers and facilitators for such utilization as a function of school grade among a sample of males from rural Nova Scotia in Canada. Methods: A 76-item self-completion survey was developed to obtain quantitative data on male students' use and perceptions of YHCs. The survey was pilot tested in June of 2009 and subsequently revised for readability and layout purposes. In October 2009, the revised survey was administrated to male youth in grades 10-12 at 4 high schools in Cape Breton, Nova Scotia. Results: Although more than 50% of the participants reported that they would be comfortable using the YHC in their school, only 16.5% had ever accessed the center, and only 5% indicated frequent use. Differences according to grade were noted, especially regarding knowledge of YHCs and intention to use a variety of YHC services. Conclusions: School-based YHCs are becoming more common as a means of responding to adolescent health needs. Despite experiencing numerous health challenges, male youth continue to underutilize these services. Multisectoral health promotion strategies are needed, especially in higher grades, to help create an environment that encourages utilization of YHCs. (Contains 5 tables.)