testing for hair loss

Question
QUESTION: Hi Dr. P., You have helped me so much in the past that I was hoping I could trouble you for another question.  I am going to see my endo this week to check my blood to make sure my Spiro isn't causing problems.  What else should I have her test?  We test for Serum Ferritin every visit - I am usually b/n 4-11 every time and can't seem to bring it up!!  She has checked my thyroid too, but I'm wondering if there is an aspect of the thyroid test that she is missing.  Generally, my Endo checks the "obvious" things.  I wanted to know if there is some other underlying problem that we're not addressing.  I am currently on Spiro, a high estrogen dose bcp and Rogaine.  I'm see lots of new growth in the last 3 months, but wonder if it is more to do with increased estrogen than anything else.  Any thoughts on what tests to make sure I have done this week?  Thanks so much.  -carla



ANSWER: I do not know why you are wondering about other tests when your serum ferritin has shown you are TOO LOW. Your serum ferritin should be over 60 as a minimum. If you can not get it up to that level with the supplements you are taking you may need iron shots but I would suggest you see a "Hematologist" to find out why you are so low. I would not be looking for other causes and would not do repeated thyroid tests. The "obvious" things only need to be checked once and you now have an "obvious" cause for you loss. What is not "obvious" is the reason you have such a low serum ferritin and you need a blood specialist for that, or perhaps a gastroenterologist to find out why you are not absorbing the iron.



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QUESTION: I hear what you are saying about my ferritin levels and I will certainly see a hemtologist to figure out why it is so low; but I have seen a dozen doctors and no one has picked up on my low ferritin levels.  I have tried to discuss it with my derm and he blows me off.  My iron levels are normal but my iron stores are super low.  Just had some blood work done today after being on iron for 2 months so I'll see if it helped.  The problem with iron is that is gives me incredible constipation that I can't seem to control. So I don't use iron supplements for very long.  If you recommend something to help with that side effect, please let me know.  I have slow fe iron supplements just waiting in my cabinet...  Thanks for your reply Dr. P, I'll look into setting an appt with a hematologist.  Maybe that has been my problem all along... :(  -carla


Answer
I may have already sent you a handout I give to women with low serum ferritin and thinning hair but if not here are three other references you can give to your doctors.  If you have a persistent low serum ferritin then you should be seeing a specialist in that area. Given a choice most women will find a way to get their ferritin up to normal rather than have thin hair.

The diagnosis and treatment of iron deficiency and its potential relationship to hair loss.



Trost LB, Bergfeld WF, Calogeras E.



J Am Acad Dermatol. 2006 May;54(5):824-44. Review.PMID: 16635664





Decreased serum ferritin is associated with alopecia in women.



Kantor J, Kessler LJ, Brooks DG, Cotsarelis G.



J Invest Dermatol. 2003 Nov;121(5):985-8.PMID: 14708596 [PubMed - indexed for MEDLINE]Related articlesFree article

3.



Decreased serum ferritin and alopecia in women.



Rushton DH.



J Invest Dermatol. 2003 Nov;121(5):xvii-xviii.  PMID: 14708588