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Low iron and hair loss - Do I need an iron transfusion?

Iron transfusions low iron and hair loss- when do I need a transfusion?

A common question that I'm asked is when are iron infusions needed for individuals with low iron levels (i.e. low ferritin level).  One key point rules the discussion - unless 3-6 months of iron pills have been used, iron infusions are not generally going to be recommended. We call this a 'trial of iron oral iron supplementation."

Unless a trial of oral iron supplementation has been done, iron infusions are pretty unlikely to happen. 

Low iron in Women

First off, it's important to know that low ferritin levels are very common in women. 30 % of premenopausal women have low iron.  Low iron with normal hemoglobin levels is also very common.  Low iron in young women is common. Low iron after an illness is not too uncommon either.

In order to fully assess if someone qualifies for iron infusions it's critical to know one's age, medications, medical history. In other words, a whole bunch of other factors matter.  The question of iron infusions is not usually just yes or no. But unless an individual tells me they have had 3-6 months or oral iron supplementation and his or her ferritin level didn't show any move upwards - they probably don't qualify for iron infusions. Exceptions do this do exist.


Improving oral iron supplementation

It takes time for iron levels to move up. Be sure to take with vitamin C to improve absorption. Be sure to take enough. If constipation happens, use lots of fiber in the diet and consider new iron pills that are less likely to cause constipation and GI upset in general.  Limit coffee and teas. Limit antacids



Iron supplementation is done in several cases. This list is not complete - AND it also depends on the hematologist who sits in front of you. Here are some common reasons for IV iron.

1. Individuals who have tried iron pills for several months and ferritin levels don't raise!

2. Individuals who just can't tolerate iron pills on account of GI upset.

3. Individuals who are losing iron fast - and can't keep up with levels by simply taking iron pills

4.  Individuals with nondialysis-dependent chronic kidney disease, obstetric indications, heart failure, heavy bleeding wth menstrual cycles and anemia associated with cancer and its treatment (chemotherapy induced anemias).

5. Individuals with inflammatory bowel disease - whereby oral iron can aggravate symptoms

6. Individuals who can't maintain iron levels with hemodialysis. 

7.  individuals with low iron after gastric bypass and other stomach surgeries. 



In most people, a 'trial' of oral iron is generally needed before considering IV iron therapy.

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Does eating watermelon help stop hair loss?


I buy watermelon after watermelon 🍉during the Summertime. Based on  "Dr Google", watermelon consumption seems pretty good for hair too👍. But I don't buy it 👎.

"Dr Google" is a phrase that my own patients taught me. The term refers to the vast amount of medical information that can be easily obtained from the internet.

The world  loves Dr Google.🏅❤️ I love Dr Google. ❤️ I am frequently looking to see just what Dr Google thinks about countless numbers of topics in hair loss.

Does consuming watermelon help stop hair loss?🍉
Does drinking a lot of water 💦help my hair?
Is waking up early in the morning 🕓good for hair?
Can the odour 👃of a new car 🚗 result in hair loss?

No matter what question you raise, Dr Google has probably written something on it. However, it does not mean that "something" is correct.


Watermelons and Hair : No evidence

Let's return to the subject of watermelons and hair loss 🍉. Those who write about the benefits of watermelon for hair loss claim that watermelon is loaded with the amino acid citrulline which gets converted in the human body to another amino acid called arginine. Arginine is a vasodilator and proponent of its benefits for hair claim this helps increase blood flow to the scalp which in turn is good for helping hair loss.

The claim that watermelon is good for hair loss has no evidence. Vasodilation itself does not help as a treatment for hair loss. Increasing blood flow as a means of treating hair loss is a myth. Massaging the scalp and standing on one's head upside down  - and eating watermelon 🍉 does not help treat hair loss.

The myths prevail.

Does watermelon 🍉 help as a treatment for hair loss? I don't buy it.  However, I'm still sticking with Dr Google🏅 and I'm still sticking with watermelon. Stay cool this summer 😎⛱  

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Health, Obesity and Hair Loss:

Does unhealthy eating contribute to hair loss?

I'm often asked if healthy eating helps slow genetic hair loss. In other words, does an apple a day keep the hair doctor away? We don’t really  know how healthy eating slows hair low. However, what we do know is that unhealthy eating that leads to obesity does seem to accelerate hair loss.


Two studies support a relationship between obesity and hair loss

A 2011 study looked at the risk factors for male balding in policeman in Taiwan. Interestingly, young male policemen who were obese had much higher rates of male balding than thinner policemen.

In 2014, researchers from Taiwan explored whether there was a relationship between obesity the severity of male balding. They studied 142 men (average at 31 years) with male balding who were not using medicines for hair loss.   The study showed that men with more severe  hair loss tended to be more overweight than men with less severe hair loss.  In fact, men who were overweight or obese had an approximately 3.5 fold greater risk for severe hair loss than men with more normal weights. In addition, young overweight or obese men had a nearly 5 fold increased risk of severe hair loss.


Does an apple a day keep the hair doctor away?

We don't really know the role of healthy eating - does it slow hair loss? That's unknown. What we do know is that the flip side appears true - that extremes of unhealthy eating leading to obesity do seem to be associated with accelerated hair loss. Overall, these two studies mentioned above do support the notion that being overweight might contribute in a negative manner to balding in men. 

Further studies are needed to determine whether encouraging weight loss in obese patients could impact the rate of balding or the effectiveness of treatments for male balding.





Chao-Chun Y et al. Higher body mass index is associated with greater severity of alopecia in men with male-pattern androgenetic alopecia in Taiwan: A cross-sectional study.  J Am Acad Dermatol 2014; 70; 297-302.

Su LH et al. Androgenetic alopecia in policemen: higher prevalence and different risk factors relative to the general population (KCIS no. 23). Arch Dermatol Res. 2011 Dec;303(10):753-61


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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More Pieces to the Vitamin D Puzzle

More Pieces to the Vitamin D Puzzle

At least once a day, I’m asked about the role of vitamin D in hair loss. Back in July, I wrote a blog article about the role of vitamin D in hair loss.   Vitamin D does its job inside cells by binding to the vitamin D receptor or VDR.

How important is vitamin D in helping prevent hair loss in humans?

Modern science still doesn’t have all the answers. But by turning to research in mice, we have learned a lot or valuable lessons.  About 10 years ago, we learned that hair loss develops in mice that lack the vitamin D receptor (VDR). Researchers in San Francisco recently discovered a molecule called MED1 which helps the action of the vitamin D receptor. In fact, the researchers found that if they blocked the actions of MED in mice those mice grew less hair. The research findings were recently discussed on the NBC today's show:

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These data suggest that defects in MED1 or defects in vitamin D signaling could potentially be involved in the development of certain types of hair loss – but more research is needed.


1. Vitamin D has an important role in hair growth – mice that lack the vitamin D receptor (VDR) develop hair loss and mice that lack an activator of the VDR (called MED) develop hair loss

2. It’s more complicated than simply taking more vitamin D pills. Don’t think for a minute that popping more vitamin D pills is going to lead to more hair growth.


Xie et al. Lack of the vitamin D receptor is associated with reduced epidermal differentiation and hair follicle growth. J Invest Dermatol 2002; 118: 11-6.

Oda Y et al. Coactivator MED1 Ablation in Keratinocytes Results in hair Cycling Defects and Epidermal Alterations. Journal of Investigative Dermatology 2012; 132: 1075-83

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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More Benefits of Checking Iron Levels in Women with Hair Loss

Checking Iron Levels in Women with Hair Loss

As many of my patients know, iron metabolism is one of my favourite subjects. It also forms one of the components of the hair loss research that I do. 

I generally recommend that all women with concerns about hair loss have their iron levels checked using the simple blood tests called ferritin. Other blood tests may also be ordered for women with hair loss, such as thyroid tests and a complete blood test to measure the hemoglobin level.

Although it is somewhat contraversial among hair experts around the world, the iron level I like my patients to aim for is a ferritin level above 40-50 ug/L.  If the blood test shows less than this, then I recommend supplementation with iron pills.


New research outlines additional benefits of checking iron levels in women

In a recently published study, Swiss researchers studied 198 premenopausal women who had ferritin levels less than 50 ug/L and symptoms of fatigue. A proportion of women in the study received ferrous sulphate pills and another proprotion of women received placebo pills.


What were the results of the study?

At the end of the 12 week study, women who received iron noted a significant improvement in their overall level of fatigue compared to women receiving the placebo pills.  The ferritin level in women recieiving the iron pills increased by approximately 12 ug/L over the 12 weeks of the study.



Many premenopausal women have low iron levels. This study reminds us that there are many improtant benefits of iron, including helping improve the overall feeling of fatigue (if levels are low). Although I routinely follow iron levels in  my patients, this study reminds us that asking about improvement in fatigue levels may also be an important parameter to assess in making a decision about continuing iron supplements for the longer term.


Vaucher P et al. Effect of iron supplementation on fatigue in nonanemic 
menstruating women with low ferritin: A randomized controlled trial. CMAJ 
2012 Aug 7; 184:1247. (Click link for article)



Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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Iron and Healthy Hair

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Iron has an important role in hair growth.  But consuming too much iron could potentially be harmful rather than helpful.  Patients often wonder if they should be consuming more iron to their help hair loss. Do you really need more iron?

Iron deficiency is the most common nutrition deficiency in North America. Iron deficiency refers to a state when the storage levels of iron in the body are reduced. When iron storage levels are reduced enough, the body can’t make enough haemoglobin and can’t make enough red blood cells to carry oxygen around the body.  When the haemoglobin levels drop below a certain level, a condition develops called "anemia."   Therefore, an individual may develop iron deficiency first and then develop anemia over time.

Iron deficiency is common and there are many causes. In fact, there are dozens of reasons to have low iron. It’s important to check with a physician to evaluate specific causes of iron deficiency.Iron deficiency is especially among pre-menopausal women on account of blood loss from menstrual cycles.    Because iron has an important role in hair growth, I routinely ask patients to get blood tests to measure haemoglobin levels as well as various iron tests.  The most common iron test is called the ‘ferritin test.’  For optimal hair health, I recommend patients take increase their daily intake of iron until ferritin levels rise above 40-50 ug/L. Levels below 20 ug/L can often be associated with hair shedding even if the patient has not yet developed an anemia.

If haemoglobin levels or ferritin levels are low, I recommend the patient be evaluated by a physician.  Sometimes an individual simply needs to consume more iron. This can come from meat, chicken, fish, grains and eggs as well as other foods.  Patients with significantly reduced iron levels, may also be advised by their doctor to take iron tablets.  

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887
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