What level of ferritin should I aim for ?

What level of ferritin should I aim for to keep my hair growing?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in iron deficiency and the threshold level of ferritin to aim for.

Question

I have hair loss and my ferritin is 33. I’m a 37 year old woman and in excellent health. I am not vegetarian. I eat well and exercise every day. I’m wondering what level I should aim for? I’ve heard 40 is a good target but some say 70. What level is reasonable?

Answer

One of the biggest myths in the field of hair loss is that there is a magic number. Not so. I wish there was, but there is not.

Certainly it makes sense to aim for a ferritin level of 40-50 if one has hair loss.

However, the reality is many many people have zero iron related issues provided the ferritin is above 30. Sure, a very small proportion might. Now as ferritin levels dip down into the 20s, there will be some that have iron issues that are related to the hair. But lots and lots and lots of females have ferritin 24-32 and have zero hair loss issues at all. So it’s not a clear cut number!

The following table provides some insights into how I think about ferritin levels for most women. One can seen that as the ferritin dips down below 70, it becomes more and more likely that taking iron could help - especially if the levels are less than 26. With ferritin levels in the teens - it’s clear iron is needed!

In summary, there are hundreds of patients today with ferritin levels 32-40 who will be told “you just need to bring up your iron to 50 or 70 and you’ll be fine.” Most of the time increasing ferritin (when levels are in the 30s is simply not going to have any effect on the hair. Is it worth trying? Well that requires input from a health care provided. As ferritin gets lower and lower below 30 it becomes more and more likely that iron supplementation will help.

I would like to point out that I never just look at the ferritin. I look at B12 (which can make ferritin levels look artificially good if B12 is low) and I look at hemoglobin, MCV, MCH and RDW and transferrin saturation if available. Most importantly I look at prior labs to see how things used to be. If one wants a magic cut off number, I’d say 40 but it’s really not so simple and lots of people eat iron pills and get constipated just to reach a number that has absolutely no benefit.

If a patient has had ferritin of 34 for 20 years and now developed hair loss last year with a ferritin of 35, are we do tell the patient “Oh you lost hair because of low iron! Bring your ferritin up to 40 to 50 and you’ll be fine.” No, this is nonsense but a common scenario.

I hope this helps with understanding the complexities of iron.