COVID-19 is placing stress on Canada's public health system. Our clinic is starting to offer virtual care to make sure that we can continue to care for our patients safely and effectively. This means that we will be using video and audio technologies for some patient visits rather than asking all patients to come into our office. Some of these technologies are provided by the Province. Others have been provided by vendors like Google, or Apple to help make discussions with your care provider as easy as possible during these difficult times. Some health concerns can be addressed with virtual care alone, but in some cases your doctor may ask you to visit a hospital or other health care facility if necessary, for a physical examination.

We do our best to make sure that any information you give to us during virtual care visits is private and secure, but no video or audio tools are ever completely secure. There is an increased security risk that your health information may be intercepted or disclosed to third parties when using video or audio communications tools. To help us keep your information safe and secure, you can:

Understand that emails, calls, or texts you receive are not secure in the same way as a private appointment in an exam room.

Use a private computer/device (i.e., not an employer's or third party's computer/device), secure accounts, and a secure internet connection. For example, using a personal and encrypted email account is more secure than an unencrypted email account, and your access to the Internet on your home network will generally be more secure than an open guest Wi-Fi connection.

You should also understand that electronic communication is not a substitute for in-person communication or clinical examinations, where appropriate, or for attending the Emergency Department when needed (including for any urgent care that may be required).

If you are concerned about using video or audio tools for virtual care, you can ask our office to arrange for you to visit a different healthcare provider or other health care center where you can be seen in person. However, please note that visiting a health care provider in person comes with a higher risk of coming into contact with COVID-19 and the possibility of spreading the virus.

By providing your information, you agree to let us collect, use, or disclose your personal health information through video or audio communications (while following applicable privacy laws) in order to provide you with care. In particular, the following means of electronic communication may be used (identify all that apply): email, videoconferencing (including Skype, Facetime, etc.), text messaging (including instant messaging), website/portal, OnCall.

Update About Our Office During This Outbreak of Corona Virus : March 15, 2020

On the advice of the Ministry of Health we are changing our office protocols to ensure minimization of risk to our patients and our staff.

Starting the week of March 16, 2020 we will try to change as many patients visits as we can to virtual electronic visits. Initially most will be by phone. There are some patients who have already made arrangements to come to the office and, if they do, we will see them, once again minimizing risks by using frequent hand washing and minimized personal contact.

For the majority of scheduled patients we will set up visits through OnCall Health. One of the problems with phone visits is that each person requires individualized attention and some visits unexpectedly may take longer than others. We will make every effort to keep on schedule but at times we may be delayed.

Dr Lawrence Komer
Medical Director
The Komer Clinics

COVID-19 Annoucement | Office Updates

Testosterone & Time | Dr. Lawrence D. Komer Medical Professional Corporation

Dr. Lawrence D. Komer Medical Professional Corporation

Testosterone Over The Long Term?

Q: OK -so if one has Andropause– still that begs the aging/ageless question(s):
1) saying aging causes Leydig cell failure -is a circular argument//pat answer-
Why does the Leydig cell not respond to LH? ..b/c the L-cell is old? HPG axis is de-sensitized?

I’M CONVINCED THAT T.R.T. HAS GREAT BENEFITS; but what about long-term dependence? i.e. testicular atrophy ONCE you start -your gonads will shrivel-up to nothing!

IS IT POSSIBLE TO KICK-START THE “nads” in some natural way? Besides reducing adiposity (thus less aromatization of T) Resistance training, etc. Can we reduce SHBG synthesis so more T remains available? Why does the aging liver upregulate SHBG synthesis? Use an aromatase inhibitor? Chrysin is hyped as a natural anti-aromatase —but a very weak & ineffectual one I surmise.

A: There are lots of theories and few answers. We know that Leydig cell production can decrease. We know that there can be insensitivity to LH. However we also know that the testosterone receptors can become insensitive and so the same dose of testosterone will have less effect. We also know that the sex hormone binding globulin later in life can be a “rogue” type, different from the normal SHBG This rogue protein binds testosterone even more effectively than normal SHBG. When you take into account all of these factors, most men have a variety of problems.

Elevated estrogen raises SHBG. We have published a paper on the use of Letrozole to lower estrogen and thus lowers SHBG. This has worked well for our patients We have no experience with Chrisin since the methods we use to lower estrogen have been so effective.

Patients who want to maintain their fertility or testicular volume often will do well on twice-weekly HCG injections.

You hit the nail on the head by also mentioning the importance of weight reduction, strength training and a healthy lifestyle.