What are the normal ferritin levels in males and females?

Normal Ferritin Levels in Males and Females

Normal ferritin levels are 20-250 μg/L in men and 20-200 μg/L in women, with values below these ranges indicating iron deficiency and values above suggesting possible iron overload. 1

Gender-Specific Reference Ranges

Ferritin is the primary storage form of iron in the body and serves as the most specific indicator of iron stores. The reference ranges differ between males and females due to physiological differences:

Males:

• Normal range: 20-250 μg/L 1
• Average serum ferritin: 98 μg/L (geometric mean) 2
• 95% confidence range: 21-447 μg/L 2

Females:

• Normal range: 20-200 μg/L 1
• Non-menstruating females: 85 μg/L (geometric mean) 2
• 95% confidence range: 26-279 μg/L 2
• Menstruating females: Often lower, particularly when menstruation lasts ≥4 days 2

Interpretation of Ferritin Values

Low Ferritin (Iron Deficiency)

• Values <15 μg/L strongly indicate depleted iron stores 1, 3
• Values <20 μg/L are typically seen in uncomplicated iron deficiency anemia 2
• Values <30 μg/L in men and <20 μg/L in women are concerning for iron deficiency 1

High Ferritin (Iron Overload)

• Values >300 μg/L in men and >200 μg/L in women may indicate iron overload 1
• Values >1000 μg/L with elevated liver enzymes may predict cirrhosis in patients with hemochromatosis 1

Clinical Considerations and Pitfalls

Important Caveats:

1. Acute Phase Reactant: Ferritin is an acute phase reactant and can be elevated in inflammation, infection, and liver disease, potentially masking iron deficiency 1

2. Underdiagnosis in Women: Current reference ranges may lead to underdiagnosis of iron deficiency in women, as studies show 30-50% of healthy women may have no marrow iron stores 4

3. Diagnostic Accuracy: At a threshold of 30 μg/L, ferritin has approximately 79% sensitivity and 98% specificity for iron deficiency in non-healthy populations 5

4. Elderly Population: In elderly individuals (60-93 years), geometric mean ferritin levels are approximately 75 μg/L for males and 60 μg/L for females 3

When to Consider Additional Testing:

• When ferritin is normal but iron deficiency is still suspected
• When inflammation is present (check CRP or ESR)
• In patients with chronic disease where ferritin may be falsely elevated

Algorithmic Approach to Interpreting Ferritin Results

1. If ferritin <15 μg/L:

   • High probability of iron deficiency regardless of other factors
   • Investigate cause and treat appropriately

2. If ferritin 15-30 μg/L:

   • Likely iron deficiency, especially in menstruating women
   • Consider transferrin saturation (TS) test (if TS <20%, confirms iron deficiency)

3. If ferritin 30-100 μg/L:

   • May be normal or may represent iron deficiency with concurrent inflammation
   • Check inflammatory markers (CRP, ESR)
   • Consider transferrin saturation

4. If ferritin >300 μg/L in men or >200 μg/L in women:

   • Consider iron overload, especially with elevated transferrin saturation (>45%)
   • Rule out inflammation, liver disease, malignancy
   • Consider genetic testing for hemochromatosis if transferrin saturation is also elevated

Remember that a combination of ferritin and transferrin saturation provides better diagnostic accuracy than either test alone when assessing iron status 1.