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.

April 1, 2020

A note to our patients. We have suspended all in-office visits at this time due to COVID 19. However, if you have an appointment currently booked with our office you will receive a call 2 days prior to that appointments. We will advise you how we will be able to proceed. Wishing you and your family safety and vitality during this challenging time.

If you need a renewal your prescriptions during the COVID-19 #stayathome period, please have your pharmacy fax your renewal request. Our fax number is 905-639-7647. Be well!

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

Great news! The Komercare Clinics are accepting new patients for men's health. Contact your physician for a referral to the Komercare Clinics. We look forward to serving you! 905-639-2571

New Patients Welcome | COVID-19 Annoucement | Office Updates

Bioavailable Testosterone | Dr. Lawrence D. Komer Medical Professional Corporation

Dr. Lawrence D. Komer Medical Professional Corporation

Bioavailable Testosterone

Q. Is it common to find TT compensated by low SHBG so that the free T falls within the normal range? Should this be considered normal and just ignored?

Some background on me: 50 yr-old male, saw three endocrinologists over past 10 years, TT values ranged from 141 to 195 ng/dL, with normal range minimum around 240 ng/dL, not hypergonadatropic (no signs of Klinefelter’s, save eunochoid habitus with all height before puberty), low SHBG and low-normal free T (don’t remember the value, but once was below normal), no brain tumors (MRI), normal libido, but lifelong difficulty building muscle and recent diagnosis of anklyosing spondylitis. I’m not receiving any hormone therapy.

My low TT was first measured after I suspected it might be low–I had to practically beg my doctor to measure it. Ironically, the first two endocrinologists wouldn’t measured the free T–it took a rheumatologist to decide to test that.

A. Free testosterone is almost useless in assessing functional testosterone levels. SHBG tends to rise with age. The levels that have some value are Bioavailable testosterone and we base about 20% of our assessment on it and 80% on the symptoms the man is having. We have developed our own questionnaire to assess this.

Some Endocrinologist get bogged down on treating blood tests and not patients. A big factor that cannot be assessed by blood work is the sensitivity of the testosterone receptors in the cells. If the receptors have become insensitive, then even normal levels or testosterone will not work well. I believe that that is why this is a clinical and not blood diagnosis and this is what I teach to my residents and interested family practitioners.

Ankylosing spondilitis is not affected by testosterone levels.