What does a ferritin level of 86 with normal iron levels indicate in an 18-year-old female with hair loss?

Ferritin Level of 86 in an 18-Year-Old Female with Hair Loss

A ferritin level of 86 ng/mL with normal iron levels in an 18-year-old female with hair loss is within normal range and unlikely to be the cause of her hair loss. Further evaluation for other causes of alopecia is warranted.

Understanding Ferritin and Hair Loss

Ferritin is an iron-binding protein that reflects total iron storage in the body. The relationship between ferritin levels and hair loss has been studied extensively, with mixed results:

• Normal ferritin range for females is typically 20-200 ng/mL
• A ferritin level of 86 ng/mL is well within normal limits
• Some research suggests that optimal ferritin levels for hair growth may be ≥60 ng/mL 1

Interpreting Your Patient's Results

Your patient's ferritin level of 86 ng/mL with normal iron levels indicates:

1. Adequate iron stores
2. No evidence of iron deficiency
3. Iron status is unlikely to be contributing to hair loss

Evidence on Ferritin and Hair Loss

The relationship between ferritin levels and various types of hair loss remains controversial:

• Multiple studies show conflicting results regarding the association between iron deficiency and hair loss 2
• The largest case-control study (n=52) found no differences in serum ferritin or serum iron in alopecia areata patients versus controls 2
• A 2010 study found no statistically significant increase in iron deficiency in women with female pattern hair loss or chronic telogen effluvium compared to controls 3
• A 2002 study concluded there is no clear association between low serum ferritin and chronic diffuse telogen hair loss 4

Clinical Approach to Hair Loss with Normal Ferritin

Since iron deficiency is unlikely to be the cause of your patient's hair loss, consider these alternative etiologies:

Common Causes of Hair Loss in Young Women:

• Androgenetic alopecia (female pattern hair loss)
• Telogen effluvium (often triggered by stress, medications, or hormonal changes)
• Alopecia areata (autoimmune hair loss)
• Nutritional deficiencies (zinc, vitamin D, other micronutrients) 2
• Thyroid disorders
• Hormonal imbalances
• Psychological stress 1

Recommended Diagnostic Workup:

1. Complete blood count
2. Thyroid function tests (TSH, free T4)
3. Zinc levels
4. Vitamin D levels
5. Autoimmune markers if alopecia areata is suspected
6. Hormonal evaluation (testosterone, DHEAS, androstenedione) if androgenetic alopecia is suspected

Management Recommendations

Since the ferritin level is normal (86 ng/mL), iron supplementation is not indicated and would not be expected to improve hair loss. The American Gastroenterological Association recommends avoiding iron supplementation beyond what's needed to reach target ferritin (50-100 μg/L) to avoid iron overload 5.

Next Steps:

1. Evaluate for other causes of hair loss as outlined above
2. Consider dermatology referral for scalp biopsy if diagnosis remains unclear
3. Address any identified nutritional deficiencies or underlying medical conditions
4. Consider topical minoxidil for female pattern hair loss if diagnosed

Important Considerations

• A normal ferritin level does not rule out other nutritional deficiencies that may contribute to hair loss
• Hair loss often has multifactorial etiology
• Psychological impact of hair loss should be addressed, particularly in young women

In this case, with a ferritin level of 86 ng/mL, focus should be on identifying other potential causes of hair loss rather than iron status.