Many lab tests are immunoassays. They use antibodies to catch one hormone or protein in your sample, then measure how much was caught.
A large share of these tests use biotin as a handle. The lab attaches biotin to a test antibody. A surface coated with streptavidin, a protein that grips biotin tightly, pulls the antibody and its target out of the sample for measurement.
Now add thousands of micrograms of biotin to the blood. Free biotin from your supplement occupies the streptavidin before the test antibody can. The capture step fails, in part or in full.
The direction of the error depends on the test design. In a sandwich assay, the signal rises with the target, so blocked capture reads falsely low. In a competitive assay, the signal falls as the target rises, so blocked capture reads falsely high.1
Li and colleagues measured this in healthy adults. Six people took 10 mg of biotin daily for a week. Of the 23 biotin-based assays tested, nine returned clinically important false results.2 Ten milligrams is 10,000 mcg, roughly double what either of our hair formulas carries. That's a different dose, not a safe harbor. The FDA's warning covers the high-dose biotin common in hair, skin, and nail products.1