Can Iron Deficiency Cause Hair Loss? Why Even ‘Normal’ Levels May Trigger Shedding
Learn the symptoms and how to boost your levels to stop the shedding
Have you ever felt “off” and gotten bloodwork done, only to find out your results were all within the “normal” range? That can often happen with seemingly unexplainable symptoms like fatigue and hair loss. But many women may be surprised to learn it’s common with iron testing, too. Low iron levels that fall within the normal range can still make our hair fall out, sinking our confidence in the process. Here, we clear up the confusion surrounding the link between subclinical iron deficiency and hair loss.
What are normal iron levels for women?
One of the things doctors check when testing for iron is ferritin. This measures iron stored in the body in places like our liver and bone marrow. It is used to make hemoglobin, the oxygen-rich protein in red blood cells. The range of “normal” ferritin in adult women is between 15 to 150 ng/mL. But that wide range leaves plenty of room for problems.
In short: Ferritin is the best test to gauge iron status. Low ferritin represents a long-term status of iron deficiency in the body. Whereas low iron in our blood serum can be a temporary blip that might follow things like blood donation or a recent illness.
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What the research says about low iron and symptoms
Doctors tend to diagnose low iron when ferritin levels dip between 12 to 30 ng/mL. But research published in the journal Nutrients proves that the “normal” end of low might already be too late to prevent a health crisis. After studying 228 patients who were not yet showing symptoms, the team found that the participants’ bodies began to behave like they were deficient as early as dropping below 50 ng/mL (still well within the “normal” range.) And mysterious hair loss is one of the first signs that something is amiss.
When ‘normal’ iron levels aren’t enough
So why aren’t normal iron readings really normal? “Unfortunately, what are considered ‘normal ranges’ based on the average population are not the same as optimal ranges or even asymptomatic ranges,” says board certified internal medicine specialist Emi Hosoda, MD.
Depending on the population, “normal” can actually mean ill. After all, normal in the US includes 93 percent of adults being classified as metabolically unhealthy, according to Tufts University data, citing high rates of obesity and diabetes. That’s why, when considering blood test results, Harvard-trained women’s health expert Sara Szal Gottfried, MD, asks, “Do you want to be ‘normal’ or optimal?”
How low iron causes hair loss
Our bodies use iron to nourish our scalp and grow hair. Dr. Hosoda explains, “We need enough iron to ensure hair follicles can support rapid cell division, oxygen transport and keratin production. This prevents the premature shift to follicles’ resting phase [called telogen effluvium] that causes thinning and shedding.”
But when our ferritin storage houses dwindle, the body redirects minerals away from hair regrowth and sends them to more critical places like our heart and brain to keep us alive.
How much iron do you need to prevent hair loss?
Remember how a lowly score of 15 was still considered “normal?” Dr. Hosoda cautions, “People, most especially peri-menopausal women, can have hair loss at ferritin levels any less than 50 to 70 ng/mL.” She adds, “And yet I see balding women all the time whose doctors told them their ferritin of 30 was okay and they should use Rogain!”
Hair loss isn’t based on iron deficiency alone
If you’re concerned about thinning hair, also check for deficiencies in blood tests that screen for:
• Vitamin D
• Zinc
• B12 and B7 (biotin)
• Vitamin C
• Thyroid
Low iron thresholds and symptoms
Dr. Hosoda says these ferritin ranges, though still considered “normal,” can accompany frustrating health symptoms:
• Under 70 ng/mL. A symptom that strikes in this broad range is restless leg syndrome (RLS). Dr. Hosoda says, “I have seen people who have come to my practice looking for answers with a ferritin level between 15 to 60 ng/ml when the literature for restless legs advocates for at least a 70 ng/mL level.”
• 30 to 50 ng/mL: Symptoms can include hair loss, fatigue and anxiety. Also heart palpitations, since iron helps regulate our nervous system, or our fight-or-flight response.
• Under 30 ng/mL: Symptoms including significant fatigue, cold intolerance, insomnia, headaches, moodiness and brain fog.
The good news: Supplementing can help
Talk to your doctor about taking iron supplements (or in some cases, getting a transfusion) to help reverse symptoms of iron deficiency. This will help build up your body’s iron stores and help treat hair loss. The goal, Dr. Hosoda says: Build ferritin up to 70 to 100 ng/mL. (Learn more about normal ferritin levels by age.)
You can also add more iron–rich foods such as beans, spinach, pumpkin seeds, lean red meat and shellfish to your diet. If levels continue to stay low despite supplementation and dietary changes, you may have an iron absorption issue. Ask your doctor to check your gut health to determine if other issues, such as celiac disease, may be at play.
What if iron is too high?
It’s important to note, says Dr. Hosoda, “that very high ferritin can be associated with hair loss too, but it’s often a sign of an underlying issue like inflammation, infection, liver disease or a genetically inherited iron-storage disease called hemochromatosis rather than the iron itself directly affecting hair.” If your iron is extremely high, it can impact organ function, especially the liver’s ability to detox the body.
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