Why Your Iron Levels Look "Normal" But Your Hair Is Falling Out (And Your Energy Is Gone)
- Monique Rey
- 3 hours ago
- 6 min read
You've been to the doctor. Again.
You told them about the exhaustion that no amount of sleep fixes. The hair that's thinning at your temples. The brain fog that makes you feel like you're moving through molasses. The cold hands and feet, even in summer.
And they ran your labs.
"Your iron is normal," they said. "Everything looks fine."
But you don't feel fine. Not even close.
Here's what's really happening: Standard iron testing is missing the most important piece of the puzzle.
The Problem With "Normal" Iron Labs
When most doctors check your iron, they're running a basic test called serum iron or sometimes hemoglobin. These tests tell you how much iron is circulating in your blood right now—but they don't tell you how much iron your body has stored for future use.
Think of it like checking your checking account but never looking at your savings. Sure, you might have enough money to get through today, but if your savings are empty, you're one unexpected expense away from trouble.
That's exactly what's happening with your iron.
Your body can pull iron from storage (ferritin) to keep your serum iron looking "normal" on a lab test—even when you're severely depleted.
What Is Ferritin (And Why Does It Matter So Much)?
Ferritin is a protein that stores iron in your body. It's your backup supply, your savings account.
When your ferritin is low, your body is running on fumes—even if your serum iron looks fine.
And here's the kicker: Ferritin is almost never tested in a standard iron panel.
Low ferritin causes:
✗ Hair loss (especially at the temples and crown)
✗ Chronic fatigue that doesn't improve with rest
✗ Restless legs at night
✗ Brain fog and difficulty concentrating
✗ Weakness and dizziness
✗ Cold hands and feet
✗ Pale skin and brittle nails
✗ Shortness of breath with minimal exertion
✗ Heavy or irregular periods (which then depletes iron further)
Sound familiar?
The Labs You Actually Need
If you suspect low iron or ferritin, here's what you need to ask your doctor to run (or order yourself through a functional lab):
Complete Iron Panel:
Serum Iron – how much iron is in your blood right now
Ferritin – your iron storage (THE most important marker)
TIBC (Total Iron Binding Capacity) – how well your body can transport iron
Transferrin Saturation – the percentage of transferrin that's carrying iron
Why Each Marker Matters:
Ferritin is your number one priority. Optimal levels are 50-100 ng/mL for women (not just "above the low end of normal" which is often 12-15 ng/mL).
If your ferritin is below 50, you're likely experiencing symptoms—even if everything else looks "normal."
TIBC and Transferrin Saturation help us understand why your iron might be low.
High TIBC with low ferritin? Classic iron deficiency. Normal TIBC with low ferritin? Could be inflammation or chronic disease affecting absorption.
The Ferritin-Thyroid Connection (This Is Where It Gets Interesting)
Here's what most people don't know: Low ferritin directly impacts your thyroid function.
Iron is required for the enzyme that converts T4 (inactive thyroid hormone) into T3 (active thyroid hormone). Without adequate iron stores, your thyroid can't do its job properly—even if your TSH looks "normal."
This is why so many women with low ferritin also have:
Unexplained weight gain
Thinning hair (from BOTH low ferritin AND sluggish thyroid)
Cold intolerance
Slow metabolism
Difficulty losing weight despite eating well
Persistent fatigue
You can have "normal" thyroid labs and still be functionally hypothyroid if your ferritin is low.
At Her+Well, when we run comprehensive bloodwork, we're looking at:
Full thyroid panel (TSH, Free T4, Free T3, Reverse T3, thyroid antibodies)
Complete iron panel (including ferritin)
Inflammation markers (hsCRP, which can suppress iron absorption)
Nutrient status (B12, folate, vitamin D—all needed for iron utilization)
Because your body doesn't work in silos. Your iron affects your thyroid. Your thyroid affects your hormones. Your hormones affect your energy, mood, metabolism, and cycles.
Everything is connected.
Why Your Ferritin Might Be Low (Even If You Eat Meat)
Low ferritin isn't always about diet. Common causes include:
1. Heavy Periods
You're losing 30-80 mL of blood every cycle. That's a LOT of iron leaving your body monthly. If you're not replenishing it, your stores tank.
2. Poor Gut Health
Iron is absorbed in your small intestine. If you have:
Low stomach acid (common with stress, age, or antacid use)
Gut inflammation (celiac, Crohn's, IBS)
Dysbiosis (imbalanced gut bacteria)
...you're not absorbing the iron from your food, no matter how much red meat you eat.
3. Chronic Inflammation
When your body is inflamed (from autoimmune conditions, infections, or chronic stress), it hides iron in storage and won't release it. This is called "anemia of chronic disease."
Your ferritin might even look high on labs, but it's not actually available for your body to use.
4. Inadequate Intake
Plant-based eaters, vegetarians, and anyone avoiding red meat can struggle to get enough bioavailable iron. Heme iron (from meat) is absorbed much better than non-heme iron (from plants).
5. Hypothyroidism Creates a Vicious Cycle
Low thyroid → low stomach acid → poor iron absorption → lower ferritin → thyroid gets worse. Round and round.
How to Fix Low Ferritin (The Right Way)
Step 1: Test, Don't Guess Get a complete iron panel with ferritin. Know your numbers.
Step 2: Address the Root Cause
Heavy periods? We need to balance your hormones (often estrogen dominance or low progesterone).
Gut issues? Heal the gut first or supplementation won't work.
Inflammation? Find the source (food sensitivities, infections, autoimmune).
Step 3: Strategic Supplementation Not all iron supplements are created equal. Many cause constipation, nausea, and gut irritation.
I typically recommend:
Ferrous bisglycinate (gentle, well-absorbed)
Desiccated liver capsules (whole-food iron with cofactors)
Vitamin C with iron (increases absorption by 3-4x)
Avoid calcium, coffee, tea within 2 hours of iron (blocks absorption)
Lactoferrin
Step 4: Support Your Thyroid If your thyroid is sluggish due to low iron, we also need to support T4 to T3 conversion with:
Selenium
Zinc
B vitamins
Adequate protein
Step 5: Retest in 8-12 Weeks Ferritin builds slowly. We need to track your progress and adjust.
What Optimal Looks Like
Ferritin: 50-100 ng/mL (women of reproductive age)
Serum Iron: 60-150 µg/dL
Transferrin Saturation: 20-40%
TIBC: 250-450 µg/dL
When your ferritin is optimized, you'll notice:
✓ Energy returns (often within 4-8 weeks)
✓ Hair stops falling out and starts regrowing
✓ Brain fog lifts
✓ You don't feel cold all the time
✓ Your workouts don't completely wipe you out
✓ Your thyroid function improves
You're Not Broken. You're Just Missing the Right Information.
If you've been told your iron is "fine" but you're still exhausted and losing hair, you're not crazy. You're not lazy. You're not "just stressed."
You're depleted.
And standard testing isn't designed to catch it.
This is exactly why I created the Clarity Plan—comprehensive bloodwork analysis that looks at ferritin, thyroid, inflammation, nutrients, and hormones together.
Because your body doesn't work in isolation.
When we understand what's actually happening inside your body, we can create a plan that works.
Not Sure Where to Start?
If you’ve been told your labs are “normal” but you still feel exhausted, foggy, or depleted, you’re not alone.
Understanding your labs is only one piece — understanding how your hormones, iron, stress, and metabolism connect is where clarity begins.
I created a free Hormone Sabotage Playbook + private podcast episode to help you identify the patterns that might be keeping you stuck.
👉 Download the free playbook here.
If you’re ready for a guided foundation plan, you can also explore the Hormone Clarity Reset — designed to help you build sustainable habits that support your energy long-term.
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References:
Hershko C, Hoffbrand AV, et al. Role of autoimmune gastritis, Helicobacter pylori and celiac disease in refractory or unexplained iron deficiency anemia. Haematologica. 2005;90(5):585-95.
Beard JL, Tobin BW. Iron status and exercise. Am J Clin Nutr. 2000;72(2):594S-597S.
Zimmermann MB, Hurrell RF. Nutritional iron deficiency. Lancet. 2007;370(9586):511-520.
Hercberg S, Preziosi P, Galan P. Iron deficiency in Europe. Public Health Nutr. 2001;4(2B):537-545.
Disclaimer: This information is for educational purposes only and is not a substitute for medical advice. Always consult with your healthcare provider before starting any supplementation or making changes to your health routine.
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