Can High Ferritin Cause Hair Loss?
No, high ferritin levels are not associated with hair loss; rather, low ferritin (iron deficiency) is more commonly linked to various types of hair loss, particularly in women. 1
Relationship Between Iron Status and Hair Loss
Low Ferritin and Hair Loss
- Iron deficiency is one of the most common nutritional deficiencies worldwide and is associated with chronic diffuse telogen hair loss 1
- Iron serves as a cofactor for ribonucleotide reductase, the rate-limiting enzyme in DNA synthesis, making it crucial for tissues with high cellular turnover like hair follicles 1
- Serum ferritin is the primary indicator of iron status used in hair loss studies, reflecting a patient's total iron storage 1
- In a 2023 study, iron deficiency (defined as serum ferritin <60 ng/mL) accounted for 70.3% of female alopecia cases 2
Evidence for Iron Deficiency in Different Types of Hair Loss
- Some studies have found lower ferritin levels in patients with various types of hair loss including:
- A 2020 study found that mean serum ferritin levels were significantly lower in patients with hair loss (14.72 ±10.70 ng/ml) compared to healthy individuals (25.30 ±14.41 ng/ml) 3
- A 2022 study observed overall mean serum ferritin levels of 20.47±17.50 in alopecia cases versus 27.87±17.51 in the control group, with a statistically significant difference (p=0.005) 4
Conflicting Evidence
- Despite these findings, there are contradictory results in the literature:
- The largest study of AA patients (n=52) found no differences in serum ferritin or serum iron between AA patients and controls 1
- A 2002 study found no direct relationship between low serum ferritin and hair loss, questioning the usefulness of serum ferritin testing in routine investigation of women with chronic diffuse telogen hair loss 5
- Gender differences exist in study findings - studies supporting an association between iron deficiency and AA have primarily been in female subjects 1
High Ferritin and Health Implications
Causes of Hyperferritinemia
- High ferritin (hyperferritinemia) is most commonly associated with:
- Chronic alcohol consumption
- Inflammation
- Cell necrosis
- Tumors
- Non-alcoholic fatty liver disease (NAFLD)/metabolic syndrome 6
- Hereditary hemochromatosis (iron overload disorder) can cause elevated ferritin levels 6
- Other causes include viral hepatitis, acute hepatitis, systemic inflammatory response syndrome, and adult-onset Still's disease 6
Hair Loss Not Associated with High Ferritin
- None of the reviewed guidelines or research evidence indicates that high ferritin levels directly cause hair loss 1
- The focus in hair loss research has been primarily on iron deficiency rather than iron excess 1
Clinical Implications
Recommended Ferritin Levels for Hair Health
- Some research suggests that serum ferritin levels ≥60 ng/mL may be optimal for hair growth 2
- A 1992 study found that patients with androgenetic alopecia responded better to treatment when serum ferritin was above 40 μg/L 7
Testing and Management
- While there is insufficient evidence to recommend routine screening for iron deficiency in all hair loss patients, testing may be beneficial in certain cases 1
- The 2023 study suggests redefining normal serum ferritin levels as ≥60 ng/mL (with corresponding hemoglobin ≥13.0 g/dL) for early diagnosis of iron deficiency-related hair loss 2
- Iron supplementation within 6 months of onset may result in better prognosis for iron deficiency-related hair loss 2
Important Considerations
- Serum ferritin has high sensitivity but low specificity for iron overload, as it can be elevated in many inflammatory conditions 6
- In the general population, iron overload is not the most common cause of elevated ferritin 1
- When evaluating ferritin levels, it's important to consider both transferrin saturation and other potential causes of abnormal levels 1, 6