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Hair Loss/Iron levels and Vit D


I've noticed overall diffuse thinning of my hair for about 1.5 years as measured by thickness of my ponytail and just the look overall. There is no thinning in front or on top of my head, the place I notice it the most is above the ears and the sides.  I went to a dermatologist a year ago and he barely looked at my hair and just thought it was genetic and due to age (46) and did not recommend any specific tests or treatment.  He recommended an overall physical exam, which I got and everything was normal except I was a bit low on Vit D (27) so I'm taking 800 IUs daily now. I also mentioned my concerns to the primary care doctor, and  asked him to test my iron levels. They came back normal, but now upon reading your book, I noticed that my ferritin level was 19, definitely on the low side. All other iron tests were in the middle or toward high end of the normal range.  Combined with the low Vit D, I'm wondering now if that is the issue with my hair.

I have never had any health problems, I weigh 128 which is normal/thin for my height. I have never smoked, and I'm not on any medication except birth control.  I also wonder if perimenopause may be to blame, I was not on birth control pills since 2004 (before that I had taken Ortho Novum 777 since age 18) and I've had very heavy periods (length 5 days, heavy bleeding first two days) since having kids in 2006 and they were becoming irregular (every 18 days) on and off for the past year. My OB just put me on Lo Loestrin FE to help with that.  I'm going to have my annual physical exam soon and I want to specifically ask about the iron/Vit D combination as newer research suggests that may be related to hair loss as shown below. After reading all your previous responses to questions, and your book, I also wonder if I should be tested for PCOS - I did have an infertility problem that was never specific, and did get pregnant with fertility treatments.

I'm frustrated because neither the dermatologist, the primary care, or the OB/GYN seems to be that interested in finding a reason for my hair issues nor a way to correct them.  Should I ask to be put on spironolactone, and do you think the birth control pill I'm on is the right one? Should I take iron supplements with Vit C as you recommend for others?  I don't want to take Yaz because of the reported side effects that are quite serious like blood clots and now subject to a lawsuit.

Can you recommend  one or more dermatologists in the Washington DC/Baltimore metro area who might be more on top of the current research and issues with female hair loss?

Thank you for your response and all your great information.

Here is the paper I referred to.

Skin Pharmacol Physiol 2013;26:101-107

Serum Ferritin and Vitamin D in Female Hair Loss: Do They Play a Role?
Rasheed H.a · Mahgoub D.a · Hegazy R.a · El-Komy M.a · Abdel Hay R.a · Hamid M.A.a · Hamdy E.b


Aim: Evaluation of serum ferritin and vitamin D levels in females with chronic telogen effluvium (TE) or female pattern hair loss (FPHL), in order to validate their role in these common hair loss diseases. Methods: Eighty females (18 to 45 years old) with hair loss, in the form of TE or FPHL, and 40 age-matched females with no hair loss were included in the study. Diagnosis was based upon clinical examination as well as trichogram and dermoscopy. Serum ferritin and vitamin D2 levels were determined for each participant. Results: Serum ferritin levels in the TE (14.7 ± 22.1 μg/l) and FPHL (23.9 ± 38.5 μg/l) candidates were significantly lower than in controls (43.5 ± 20.4 μg/l). Serum vitamin D2 levels in females with TE (28.8 ± 10.5 nmol/l) and FPHL (29.1 ± 8.5 nmol/l) were significantly lower than in controls (118.2 ± 68.1 nmol/l; p < 0.001). These levels decreased with increased disease severity. Serum ferritin cut-off values for TE and FPHL were 27.5 and 29.4 μg/l, respectively, and those for vitamin D were 40.9 and 67.9 nmol/l. Conclusion: Low serum ferritin and vitamin D2 are associated with hair loss in females with TE and FPHL. Screening to establish these levels in cases of hair loss and supplementing with them when they are deficient may be beneficial in the treatment of disease.

I believe your serum ferritin level of 19 to be low enough to take seriously and to consider it a possible reason for your thinning hair. Vit D has recently been reported as also contributing to thin hair in middle aged women but I believe it to be rare. I'd take OTC Ferrrous sulfate 325 mg + Vit C 500mg daily to get your serum ferritin above 60.
 In your first two sentences you indicate the major loss is on the sides and above your ears. This is an area rarely seen to thin out due to hormonal or nutritional reasons. Instead it is a common area to see thinned out due to wearing a ponytail. The constant tugging of hair leads to the thinning you described. It is called Traction Alopecia and although most cases are presented with women having a bald area due to the traction there are many more women who do not pull their hair as tight or wear braids pulled tight and experience thinning rather than a bald spot. A change in hair styles with avoidance of ponytails may be all that is needed. The use of 5% minoxidil lotion applied once a day in the morning for the next four to six months may help bring back recently lost hair.
  For hair loss due to PCOS I prefer to give my patients Yaz and sprironolactone. For those who wish to avoid Yaz I will give a pill such as Ortho TriCyclen plus spironolactone.
 The best hair loss guru I know of is in your area, Dr Leonard Sperling, he teaches in Bethesda. He may have his practice limited but you could call his office and ask if one of his disciples practices in your area.
I know there is some controversy regarding drospirenone but in a non smoker I think the risk really is minimal to non existent. The article below was from just two years ago.
Here is some additional information you can take to your doctor to prove Yaz is not only safe but may be beneficial- better than any of the other OCPs which contain a progestin.   Read the last line "Drospirenone does not increase the risk of ATE, and may reduce it."

Drug Safety
March 2012, Volume 35, Issue 3, pp 191-205
Oral Contraceptives and Venous Thromboembolism
Dr Lamberto Manzoli, Corrado De Vito, Carolina Marzuillo, Antonio Boccia, Paolo Villari
Background: An association between oral contraceptive (OC) use and venous thromboembolism (VTE) has long been recognized. However, no summary estimates of the increase in VTE risk associated with OC use have been available since 1995, and no meta-analyses have evaluated the VTE risk of new preparations containing drospirenone.
Objective: The aim of the study was to carry out a meta-analysis to summarize existing evidence on the association between venous VTE and OC use, and to investigate how such an association may vary according to the type of OC, OC user characteristics, study characteristics and biases.
Methods: Relevant cohort or case-control studies were searched in MEDLINE and other electronic databases up to May 2010, with no language restriction. Data were combined using a generic inverse-variance approach. Meta-regression in addition to stratification was used to explore potential predictors of the summary estimate of risk.
Results: Sixteen cohort and 39 case-control studies were included in at least one comparison. Overall, the odds ratio (OR) of OC users versus non-users was 3.41 (95% CI 2.98, 3.92). This estimate was based upon nine cohort studies evaluating approximately 12 000 000 person-years, and 23 case-control studies including approximately 45 000 women. VTE risk for OC users was significantly lower in studies evaluating ‘all VTE cases’ than in those evaluating ‘idiopathic VTE only’ (OR 3.09 and 4.94, respectively). Among the carriers of genetic mutations G20210A and Factor V Leiden (FVL), OC users showed a significantly increased VTE risk compared with non-users (OR 1.63; 95% CI 1.01, 2.65, and OR 1.80; 95% CI 1.20, 2.71, respectively). When the newest OCs containing drospirenone were compared with non-drospirenone-containing OCs (except those containing levonorgestrel only), VTE risk did not significantly increase (OR 1.13; 95% CI 0.94, 1.35).
Conclusions: This meta-analysis confirms that OC use significantly increases VTE risk. The strength of this association, however, varies according to the generation of OC, type of outcome and presence of a genetic mutation, with ORs ranging from 3 to 5.

Combined hormonal contraceptives and the risk of venous and arterial thromboembolism and cardiovascular death: misuse of automated databases.
Shapiro S
Visiting Professor of Epidemiology, Department of Family Medicine and Public Health, University of Cape Town School of Medicine, Cape Town, South Africa.
The Journal of Family Planning and Reproductive Health Care / Faculty of Family Planning & Reproductive Health Care, Royal College of Obstetricians & Gynaecologists [2013, 39(2):89-96]
Type: Journal Article
DOI: 10.1136/jfprhc-2012-100577
Abstract   Highlight Terms
BACKGROUND: In December 2011, the US Food and Drug Administration (FDA) convened a public Advisory Committee meeting to review evidence from a study commissioned by the agency. An analysis of findings derived from four databases was published on the FDA website, and presented at the meeting. Among users of combined hormonal contraceptives containing ethinylestradiol (EE) plus drospirenone (DRSP) the risks of venous (VTE) and arterial thromboembolism (ATE) were higher than among users of older reference contraceptives containing other progestogens. The findings have now been published in a peer-reviewed journal.

OBJECTIVE: To evaluate the published evidence.

METHODS: Generally accepted epidemiological principles of causality are applied.

RESULTS: The findings did not satisfy the criteria of time order, bias, confounding, statistical stability and strength of association, duration-response, internal consistency, external consistency, or biological plausibility.

CONCLUSIONS: The best evidence continues to suggest that the increased risk of VTE in combined hormonal contraceptive users is dependent on the dose of estrogen, and independent of the progestogen used. The best evidence also suggests that

      Drospirenone does not increase the risk of ATE, and may reduce it.

Hair Loss

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Peter J. Panagotacos, <B>M.D.</B>


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website

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