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Ferritin, iron and hair
Ferritin is the protein that stores iron in the body and is the best single indicator of the body’s iron stores. In the context of hair it comes up often, because increased hair shedding in women of reproductive age not infrequently coincides with low iron stores, and that even when the blood count, haemoglobin included, is completely normal.
What ferritin is and why it is measured
Iron does not move freely in the body. It binds to proteins, and ferritin is the one that stores it in the liver, spleen, bone marrow and other tissues. When the body uses more iron than it takes in, those reserves empty first, and only later do haemoglobin and red blood cells fall.
That is why a result can look like this: haemoglobin normal, red blood cells normal, ferritin low. This condition is called iron deficiency without anaemia, that is a deficiency of iron in the stores. A classic blood count does not detect it. Only measuring ferritin does, usually together with serum iron, TIBC and transferrin saturation.
Reference values and a “normal result”
The lower limit of the reference range for ferritin in laboratories is most often around 10 to 15 ng/ml for women. That limit is set to rule out anaemia, not to describe an optimal state for hair or energy. That is why it happens that a result is formally “within the reference range” while the patient still feels tired.
In the dermatological literature there has long been debate about which ferritin value is relevant for hair. Proposed thresholds differ from study to study and there is no single, generally accepted cut-off. Some research finds an association between low ferritin and diffuse hair shedding in women, while other papers do not confirm that link. The conclusion drawn from this is cautious: low ferritin is a finding worth considering, but it is not automatically the explanation for every case of hair loss.
How iron affects the hair follicle
The hair follicle is among the most metabolically active tissues in the body. The cells of the follicle matrix divide extremely quickly, faster than most cells in the body. Such division requires a constant supply of oxygen and energy, and iron is an integral part of the haemoglobin that carries oxygen, as well as of several enzymes involved in DNA synthesis.
When iron stores fall, the body prioritises. Hair is not a vital tissue, so resources are redirected to what is. The practical consequence is that a larger number of follicles enter the telogen, resting phase of the cycle prematurely. A few months later this shows as increased shedding, a mechanism described as telogen effluvium and explained in more detail in the text on hair loss.
The delay in the effect
The time lag is a source of much confusion. The event that depleted the iron stores, childbirth, heavy periods over several months, a restrictive diet, surgery, happens two to three months before the shedding becomes visible. That is why the cause is often looked for in what is happening now rather than in what was happening in the spring.
Who is at increased risk of low ferritin
- Women with heavy or prolonged menstrual bleeding
- Women in pregnancy and after childbirth, when iron needs are considerably higher
- People on vegetarian and vegan diets, because non-haem iron from plant sources is absorbed less well
- People with coeliac disease, inflammatory bowel disease or after bariatric surgery
- People who follow restrictive diets for long periods
- Endurance athletes, because of greater losses and increased needs
Ferritin is not always reliable
It is worth knowing the other side too. Ferritin is a so-called acute phase reactant: it rises in the presence of inflammation, infection and in some chronic diseases. That means that in a person with an active inflammatory process ferritin can appear normal or even elevated, even though iron stores are actually low. For that reason the result is never interpreted in isolation, but together with CRP, the blood count and the overall clinical picture. Interpretation belongs to a doctor.
Iron in the diet
Iron in food exists in two forms. Haem iron from meat, liver and fish is absorbed considerably better. Non-haem iron from legumes, dark leafy vegetables, seeds and wholegrains is absorbed less well, but absorption improves when vitamin C is present in the same meal, for example lentils with pepper or lemon.
Coffee, black and green tea, as well as calcium supplements taken with a meal, act in the opposite direction. Consuming them at the same time reduces the usability of iron from food.
On supplementation
Iron supplements are not taken “just in case”. Excess iron in the body is not harmless, and in some hereditary conditions such as haemochromatosis it is distinctly harmful. The decision on supplementation, the choice of preparation and the duration of use are made by a doctor on the basis of test results. The same goes for the follow-up tests used to monitor the response.
Where hair care fits in
This is an important distinction. If hair is in telogen effluvium because of low ferritin, the solution lies in correcting the deficiency: a cosmetic product cannot replace iron. Hair care and cosmetic preparations, including serums and ampoules and peptide formulations, act on the surface of the scalp and the hair; they do not affect the body’s iron stores and do not replace a medical work-up.
The practical order is therefore simple: first establish whether there is something systemic that can be corrected, and only then consider a care routine.
In short
- Ferritin shows iron stores and can be low even when the blood count is normal.
- The hair follicle is metabolically demanding, so it reacts to iron deficiency earlier than most tissues.
- The effect is seen two to three months after the cause.
- Ferritin rises in inflammation, so the result is interpreted in context, by a doctor.
- Iron supplements are taken only on the basis of test results and medical advice.
- Cosmetic care does not replace correcting the deficiency.
This text is informative in character and does not constitute medical advice, a diagnosis or a treatment recommendation. For interpretation of results and any treatment consult a doctor.