LOW IRON CAUSING ALOPECIA

by Gary M. White, MD

Low iron is a common cause of thinning hair in a young woman. The typical situation is 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. Occasionally, a women with relatively normal or even light periods can still be low in iron if she absorbs iron poorly or donates blood.

The best way to test for this condition is a blood test--ferritin which is usually below 40. When faced with low iron, the body sacrifices the hair before the blood. Thus, the CBC is usually normal--making it an unhelpful screen for this condition. If the ferritin is below 40, iron supplementation should be started. The goal is to get the ferritin above 40. This may take several months. Once it is, it may take 4-6 months to see the full benefit on the hair. The process is slow, so be patient.

As an aside, typical labs for all woman losing hair may include ferritin, thyroid studies (e.g. T4, TSH), hormone levels (e.g. testosterone, free and total, DHEAS), vitamin D and ANA.

Treatment, Brief Overview

The most commonly recommended iron supplementation is 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. Therefore, you 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 you to take 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.

Your doctor will want to recheck your ferritin in 2-3 months to make sure the supplementation is sufficient.

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