diff --git a/src/OpenTelemetry.Extensions.Hosting/CHANGELOG.md b/src/OpenTelemetry.Extensions.Hosting/CHANGELOG.md
index 8dd8ca62f72..0afddcc2d9e 100644
--- a/src/OpenTelemetry.Extensions.Hosting/CHANGELOG.md
+++ b/src/OpenTelemetry.Extensions.Hosting/CHANGELOG.md
@@ -2,6 +2,14 @@
 
 ## Unreleased
 
+* Changed the behavior of the `OpenTelemetryBuilder.AddOpenTelemetry` extension
+  to INSERT OpenTelemetry services at the beginning of the `IServiceCollection`
+  in an attempt to provide a better experience for end users capturing telemetry
+  in hosted services. Note that this does not guarantee that OpenTelemetry
+  services will be initialized while other hosted services start, so it is
+  possible to miss telemetry until OpenTelemetry services are fully initialized.
+  ([#4883](https://github.com/open-telemetry/opentelemetry-dotnet/pull/4883))
+
 ## 1.6.0
 
 Released 2023-Sep-05
diff --git a/src/OpenTelemetry.Extensions.Hosting/OpenTelemetryServicesExtensions.cs b/src/OpenTelemetry.Extensions.Hosting/OpenTelemetryServicesExtensions.cs
index dff14ca1b38..e226dfba69a 100644
--- a/src/OpenTelemetry.Extensions.Hosting/OpenTelemetryServicesExtensions.cs
+++ b/src/OpenTelemetry.Extensions.Hosting/OpenTelemetryServicesExtensions.cs
@@ -14,7 +14,6 @@
 // limitations under the License.
 // </copyright>
 
-using Microsoft.Extensions.DependencyInjection.Extensions;
 using Microsoft.Extensions.Hosting;
 using OpenTelemetry;
 using OpenTelemetry.Extensions.Hosting.Implementation;
@@ -35,10 +34,17 @@ public static class OpenTelemetryServicesExtensions
     /// cref="IServiceCollection"/>.
     /// </summary>
     /// <remarks>
-    /// Note: This is safe to be called multiple times and by library authors.
+    /// Notes:
+    /// <list type="bullet">
+    /// <item>This is safe to be called multiple times and by library authors.
     /// Only a single <see cref="TracerProvider"/> and/or <see
     /// cref="MeterProvider"/> will be created for a given <see
-    /// cref="IServiceCollection"/>.
+    /// cref="IServiceCollection"/>.</item>
+    /// <item>OpenTelemetry SDK services are inserted at the beginning of the
+    /// <see cref="IServiceCollection"/> and started with the host. For details
+    /// about the ordering of events and capturing telemetry in
+    /// <see cref="IHostedService" />s see: <see href="https://github.com/open-telemetry/opentelemetry-dotnet/blob/main/src/OpenTelemetry.Extensions.Hosting/README.md#hosted-service-ordering-and-telemetry-capture" />.</item>
+    /// </list>
     /// </remarks>
     /// <param name="services"><see cref="IServiceCollection"/>.</param>
     /// <returns>The supplied <see cref="OpenTelemetryBuilder"/> for chaining
@@ -47,8 +53,10 @@ public static OpenTelemetryBuilder AddOpenTelemetry(this IServiceCollection serv
     {
         Guard.ThrowIfNull(services);
 
-        services.TryAddEnumerable(
-            ServiceDescriptor.Singleton<IHostedService, TelemetryHostedService>());
+        if (!services.Any((ServiceDescriptor d) => d.ServiceType == typeof(IHostedService) && d.ImplementationType == typeof(TelemetryHostedService)))
+        {
+            services.Insert(0, ServiceDescriptor.Singleton<IHostedService, TelemetryHostedService>());
+        }
 
         return new(services);
     }
diff --git a/src/OpenTelemetry.Extensions.Hosting/README.md b/src/OpenTelemetry.Extensions.Hosting/README.md
index 969828f62f1..c5d592b4e79 100644
--- a/src/OpenTelemetry.Extensions.Hosting/README.md
+++ b/src/OpenTelemetry.Extensions.Hosting/README.md
@@ -141,6 +141,10 @@ and
 [new](https://github.com/open-telemetry/opentelemetry-dotnet/tree/main/examples/AspNetCore)
 versions of the example application to assist you in your migration.
 
+## Hosted Service Ordering and Telemetry Capture
+
+TBD
+
 ## References
 
 * [OpenTelemetry Project](https://opentelemetry.io/)
diff --git a/test/OpenTelemetry.Extensions.Hosting.Tests/OpenTelemetryServicesExtensionsTests.cs b/test/OpenTelemetry.Extensions.Hosting.Tests/OpenTelemetryServicesExtensionsTests.cs
index c6a3b0a8108..181dec9e367 100644
--- a/test/OpenTelemetry.Extensions.Hosting.Tests/OpenTelemetryServicesExtensionsTests.cs
+++ b/test/OpenTelemetry.Extensions.Hosting.Tests/OpenTelemetryServicesExtensionsTests.cs
@@ -14,6 +14,7 @@
 // limitations under the License.
 // </copyright>
 
+using System.Diagnostics;
 using Microsoft.Extensions.Configuration;
 using Microsoft.Extensions.DependencyInjection;
 using Microsoft.Extensions.Hosting;
@@ -450,9 +451,48 @@ public void AddOpenTelemetry_WithLogging_NestedResolutionUsingConfigureTest()
         Assert.True(innerTestExecuted);
     }
 
+    [Fact]
+    public async Task AddOpenTelemetry_HostedServiceOrder_DoesNotMatter()
+    {
+        var exportedItems = new List<Activity>();
+
+        var builder = new HostBuilder().ConfigureServices(services =>
+        {
+            services.AddHostedService<TestHostedService>();
+            services.AddOpenTelemetry()
+                .WithTracing(builder =>
+                {
+                    builder.SetSampler(new AlwaysOnSampler());
+                    builder.AddSource(nameof(TestHostedService));
+                    builder.AddInMemoryExporter(exportedItems);
+                });
+        });
+
+        var host = builder.Build();
+        await host.StartAsync().ConfigureAwait(false);
+        await host.StopAsync().ConfigureAwait(false);
+        host.Dispose();
+
+        Assert.Single(exportedItems);
+    }
+
     private sealed class MySampler : Sampler
     {
         public override SamplingResult ShouldSample(in SamplingParameters samplingParameters)
             => new(SamplingDecision.RecordAndSample);
     }
+
+    private sealed class TestHostedService : BackgroundService
+    {
+        private readonly ActivitySource activitySource = new ActivitySource(nameof(TestHostedService));
+
+        protected override Task ExecuteAsync(CancellationToken stoppingToken)
+        {
+            using (var activity = this.activitySource.StartActivity("test"))
+            {
+            }
+
+            return Task.CompletedTask;
+        }
+    }
 }