What are the implications of a patient's elemental hair analysis showing hypochromia (low chromium), low levels of germanium, iodine, cobalt, manganese, selenium, and vanadium, and hyperlithemia (high lithium), hypermolybdenemia (high molybdenum), hypersulfuria (high sulfur), and hypercalcemia (high calcium), and what are the next steps?

Hair Analysis Results: Clinical Significance and Recommended Actions

Hair elemental analysis is not a validated clinical tool for diagnosing mineral deficiencies or toxicities, and these results should not guide clinical decision-making. The abnormalities reported have no established clinical significance and do not warrant treatment based on hair analysis alone.

Why Hair Analysis Is Unreliable

The fundamental problem with commercial hair elemental analysis is its lack of clinical validity and standardization:

• Extreme interlaboratory variability: Identical hair samples sent to different laboratories yield wildly different results, with no agreement on what constitutes "normal" ranges 1, 2
• Poor reproducibility: The same laboratory produces inconsistent results when analyzing identical samples from the same individual 2
• Contamination issues: Hair analysis cannot distinguish between minerals deposited from external sources (shampoos, environmental exposure, water) versus those incorporated during hair growth 1
• No validated reference ranges: There is no scientific consensus on normal versus abnormal levels for most elements measured in hair 1, 2

A landmark 1985 JAMA study demonstrated that commercial hair analysis laboratories provided "voluminous, bizarre, and potentially frightening" interpretations that were scientifically unfounded 2. More recent systematic reviews confirm these findings persist 3.

Specific Elements Reported as Abnormal

Low Elements (Chromium, Germanium, Iodine, Cobalt, Manganese, Selenium, Vanadium)

• Chromium, iodine, manganese, molybdenum, and selenium are recognized as essential trace elements, but hair levels do not reliably reflect body stores or nutritional status 4
• Germanium, cobalt, and vanadium have unclear or no established essential roles in human nutrition at the levels typically measured 4
• One small study found lower chromium and germanium in boys with ADHD, but this has not been replicated and the clinical significance remains unknown 5

High Elements (Lithium, Molybdenum, Sulfur, Calcium)

• Lithium: Hair levels have no established correlation with serum lithium levels or toxicity. Lithium toxicity is diagnosed by serum levels (>1.5 mEq/L suggests toxicity) and clinical symptoms, never by hair analysis 6
• Molybdenum: While an essential trace element, elevated hair levels have no validated clinical significance 4
• Sulfur and calcium: These are abundant in normal physiology, and hair levels do not indicate disease states 4

Recommended Next Steps

Do not pursue treatment or further testing based solely on these hair analysis results. Instead:

1. Clinical Assessment

• Evaluate for specific symptoms or conditions that might suggest true mineral deficiency or toxicity (fatigue, hair loss, neurological symptoms, gastrointestinal issues)
• Obtain detailed medication history, particularly lithium use if elevated lithium was reported 6
• Assess dietary intake and any malabsorption conditions (celiac disease, inflammatory bowel disease, short bowel syndrome) 4

2. Validated Laboratory Testing (Only If Clinically Indicated)

If clinical suspicion exists for specific deficiencies based on symptoms or risk factors:

• For iron deficiency (if hair loss, fatigue, or anemia suspected): Serum ferritin, complete blood count, transferrin saturation 7, 8, 9
• For selenium deficiency (if cardiomyopathy, muscle weakness): Serum selenium levels 4
• For iodine status (if thyroid dysfunction): TSH, free T4, urinary iodine excretion 4
• For lithium toxicity (if patient takes lithium): Serum lithium level, renal function, thyroid function 6

3. What NOT to Do

• Do not start mineral supplementation based on hair analysis results 1, 2
• Do not order additional hair analyses from the same or different laboratories 2
• Do not pursue chelation therapy or "detoxification" protocols 1

Important Caveats

Commercial hair analysis is considered "unscientific, economically wasteful, and probably illegal" when used to diagnose disease or recommend supplements 2. The practice persists despite decades of evidence showing its lack of validity 1, 3, 2.

If genuine concern exists about nutritional status, serum testing of specific nutrients guided by clinical presentation provides the only validated approach 4, 7. For trace elements specifically, clinical signs and symptoms combined with serum biochemical markers (when available) should guide evaluation, not hair analysis 4.