Ferritin levels: Frantic or Factual?

What are normal ferritin levels? What do they mean?

Blood tests are associated with great confusion. In other blogs, I've discussed the uselessness of DHT measurements for most patients, yet everyday patients show me results. A lot of confusion exists with TSH levels, T3, T4 measurements (all for thyroid). I'll comment on these soon too. 

For now, let's discuss ferritin. 

Iron levels are important but low iron should not cause immediate panic

Many females have ferritin levels 20-40 without hair loss. That sentence needs to be repeated over and over. And then repeated again. It's far too simple to say that ferritin levels must be above 40 for healthy hair growth. We often "AIM" for that but it is completely wrong to say that anytime ferritin is less than 40 there is a problem. The correct answer is there may be

If you were to measure iron levels (i.e. the ferritin test) in all women between ages 20-40, you'd find many with ferritin 28, 32. 44. You'd find very few with ferritin levels above 50.  You'd find a number with ferritin levels 6, 12, 19.

Misconceptions around iron levels. 

I think too often I hear women state that because their iron levels are under 40 (ie let's say 26) they MUST have a diagnosis of telogen effluvium. This is wrong. When I learn that a individual has an iron level of 26, I can only say they have an iron level of 26. They may have normal hair. They may have androgenetic alopecia (female pattern hair loss) and they may have a host of other conditions as well including alopecia areata and telogen effluvium.  Low iron levels have been associated with many hair loss conditions. 

The level of iron tells me very little. 

Ferritin levels below 15

Once the iron levels start going low enough, it is true that there is a high likelihood now that the patient will experience some hair loss an account of those low iron levels. It's quite unusual for  patient to have normal hair growth with a ferritin of 2. In general, once ferritin levels drop below 15 AND the patient has hair loss concerns, it's no longer a debate as to whether to replace iron. It's a general consensus that supplementing iron is necessary. 

Key 10 summary points about iron levels and hair loss

Here's some key 'take home' messages about iron and hair loss

1. Aiming for a ferritin level above 40 is a good idea for anyone with hair loss.

2. Aiming for a ferritin above 70 is not my recommendation and is very hard to achieve and generally has little benefit for the hair. 

3. If one's ferritin is between 20-40, it must always be remembered that the ferritin levels may be just fine for that person. I'd still recommend supplementing with iron tablets, but there is not a lot of good evidence 

4. Ferritin levels under 15 are usually associated with changes in hair cycling.  If ferritin is less than 15, I recommend speaking to one's physician about iron pills

5. If ferritin levels are low and hemoglobin levels are low (something we call an anemia), a full workup by a doctor should be booked.  

6. Vitamin C helps iron absorption and taking a vitamin C rich sources with iron pills is often helpful to increase iron. 

7. Many females have ferritin levels 20-40 without hair loss. The ferritin level alone does not mean much without taking everything into perspective. 

8. Many females have ferritin levels 20-40 without hair loss. The ferritin level alone does not mean much without taking everything into perspective. 

9. Many females have ferritin levels 20-40 without hair loss. The ferritin level alone does not mean much without taking everything into perspective. 

10. Many females have ferritin levels 20-40 without hair loss. The ferritin level alone does not mean much without taking everything into perspective.