Can iron overload cause hair loss?

Iron Overload and Hair Loss: The Connection

While iron deficiency is a known cause of hair loss, iron overload (excess iron) does not appear to cause hair loss based on current evidence. 1

Understanding Iron and Hair Health

Iron plays a crucial role in hair follicle health as a cofactor for ribonucleotide reductase, the rate-limiting enzyme in DNA synthesis 1. This makes it essential for tissues with high cellular turnover, such as hair follicle matrix cells.

Iron Deficiency and Hair Loss

• Iron deficiency is well-documented as a cause of chronic diffuse telogen hair loss 1, 2
• Serum ferritin levels below 30-60 ng/mL are associated with increased risk of hair loss in women 3, 4
• Women with serum ferritin ≤30 ng/mL have 21 times higher odds of developing telogen hair loss 4

Iron Overload and Hair Loss

• No evidence in current literature supports that iron overload causes hair loss 1
• Iron overload conditions (hemochromatosis) typically manifest with:
  • Chronic fatigue
  • Joint pain
  • Diabetes
  • Eventual organ failure (particularly pancreas and liver) 1
  • Pigmented skin 1
  • Heart failure 1
  • Multiple endocrine disorders 1

Clinical Implications

Diagnosis of Iron Status

• For suspected iron deficiency or overload, testing should include 1:
  • Plasma iron
  • Transferrin
  • Transferrin saturation
  • Ferritin
  • CRP (to rule out inflammatory conditions that can elevate ferritin)
  • Hepcidin
  • Red blood cell morphology

Treatment Considerations

• For iron deficiency with hair loss:

  • Oral iron supplementation is first-line therapy 2
  • IV iron may be considered for those not responding to oral therapy 1
  • Target ferritin levels of ≥60 ng/mL for optimal hair growth 5

• For iron overload:

  • Treatment involves iron removal by phlebotomy/blood donation in non-anemic patients 1
  • Chelation therapy may be required in transfusion-associated overload 1

Important Caveats

• Hair loss is multifactorial - iron status is just one potential contributor 6
• Studies on iron and hair loss have shown mixed results, with some showing no association between iron deficiency and certain types of hair loss 7
• Iron supplementation should be avoided in patients with iron overload conditions, as excessive supplementation can worsen the condition 2
• Patients with iron overload should be monitored for complications including liver disease and potential increased risk of liver cancer in those with hepatitis C 1

Practical Recommendations

1. For patients with hair loss:

   • Screen for iron deficiency with serum ferritin testing
   • Consider iron deficiency as a potential contributor when ferritin is <60 ng/mL 5
   • Correct iron deficiency through appropriate supplementation

2. For patients with known iron overload:

   • Monitor for typical symptoms of hemochromatosis
   • Hair loss is not an expected symptom of iron overload
   • Focus treatment on reducing iron stores through phlebotomy or chelation 1

Remember that while addressing iron status may help with hair loss related to deficiency, patients with iron overload should not expect hair loss as a symptom, nor improvement in hair growth with treatment of their overload condition.