Hereditary Hemochromatosis (HC) is a genetic condition causing the body to absorb and store excessive iron. Since the body cannot naturally excrete this excess, it builds up over time in various organs, including the liver, heart, and pancreas, leading to potential damage.
While common symptoms include joint pain and chronic fatigue, many individuals with HC also report hair thinning or loss. The relationship is complex, involving both the direct effect of iron on the hair follicle and the indirect impact of systemic damage. This article explores how excessive iron compromises the hair growth cycle.
The Direct Link Between Iron Overload and Hair Loss
Excessive iron is stored as ferritin, and high levels of this storage iron can directly disrupt the normal hair growth cycle. Hair follicles are highly active metabolic sites. Iron overload can lead to oxidative stress, where the toxic excess of iron generates free radicals that damage the hair follicle cells.
This cellular damage may prematurely signal the hair follicle to exit the active growth (anagen) phase and enter the shedding (telogen) phase, resulting in diffuse hair thinning, often referred to as telogen effluvium. Though iron deficiency is a well-known cause of hair loss, the mechanism of iron overload is distinct, involving the toxic effects of iron accumulation. The degree of hair loss often correlates with the severity of iron accumulation, as measured by elevated serum ferritin levels.
Secondary Health Conditions That Cause Hair Thinning
Not all hair loss associated with hemochromatosis is due to the direct toxicity of iron on the hair follicle. The systemic nature of iron overload means deposits can damage endocrine glands, leading to secondary conditions that independently cause hair thinning.
The pituitary gland, which regulates hormone production, is particularly susceptible to iron deposition. Iron accumulation in the pituitary can cause hypopituitarism, resulting in a deficiency of one or more pituitary hormones. Damage often leads to hypogonadism (reduced sex hormone production) or hypothyroidism.
Both low testosterone and hypothyroidism are established causes of diffuse hair loss and thinning, stemming from a hormonal imbalance triggered by the iron-damaged endocrine system. Furthermore, the chronic illness and persistent inflammation that accompany advanced hemochromatosis contribute to stress on the body, which can further exacerbate hair shedding.
Treatment and Prognosis for Hair Regrowth
The primary and most effective treatment for hemochromatosis is therapeutic phlebotomy, a procedure that involves the regular removal of blood to decrease the body’s iron stores. In the initial depletion phase, blood is often removed weekly or bi-weekly until the serum ferritin level reaches a target range, typically between 50 and 100 µg/L. This process encourages the body to pull iron from storage sites like the hair follicles to create new red blood cells.
Once the iron levels are normalized and the systemic damage is halted, the prognosis for hair health generally improves. The resolution of oxidative stress and the correction of any secondary hormonal imbalances, such as hypothyroidism, often allow the hair follicles to resume a normal growth cycle.
Hair regrowth, however, is a slow process due to the natural duration of the hair cycle. Patients who achieve and maintain target ferritin levels can expect to see a reduction in shedding and potential regrowth, though it may take between six to twelve months for noticeable improvement in hair density.
Regular monitoring of ferritin and transferrin saturation is necessary to maintain iron levels. Physicians may also check thyroid function to ensure all secondary causes of hair loss are managed.