By Gary M. White, MD
Low iron can lead to hair loss. The ferritin is usually below 40. The Fe/TIBC is also typically low. The CBC is usually normal. Sometimes the Fe/TIBC and ferritin give divergent results, e.g., the Fe/TIBC is low but the ferritin is above 40. In this case, it may be that the ferritin is acting as an acute phase reactant and the Fe/TIBC is more reliable.
When faced with low iron, the body seems to sacrifice the hair before the blood. Thus, the CBC is often normal--making it an unhelpful screen for this condition.
The patient is usually a young adult woman with heavy menstrual periods and thinning hair. There are no bald spots. Men are rarely affected as they do not lose iron via menstruation. For a differential diagnosis, see woman with hair loss.
The patient should take iron supplementation, e.g., 325 mg of ferrous sulfate starting 1/day. For some, 2-3 tablets of iron per day may be needed but constipation can occur.
Vitamin C is critical in the absorption of iron and is able to double or even triple the amount absorbed. Patients should take one vitamin C tablet with each dose of iron and one with the biggest meal of the day (to aid absorption of natural iron in the diet). This approach may allow the woman to take much less iron and avoid any constipation. Taking the iron with orange juice is an alternative. Drinking certain teas when taking iron can decrease absorption by 50% and should be avoided.
Measure the iron in 2-3 months to make sure the supplementation is sufficient. Once the ferritin is above 40, the woman may need to wait 4-6 months to see the full benefit on the hair.
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