Nurse practitioner, clinic owner, and founder of HRT University. I teach providers the physiology behind hormone therapy, so they’re not piecing it together on their own.
Why HRT isn't fixing her fatigue (check ferritin)
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Your wish is my command. Many of you have asked, so this morning, I bring to you the case for checking ferritin levels. And yes, I believe based on the literature, that it's on of the most underrated and helpful markers when it comes to discovering iron deficiency. Let me make the case here. First of all, most iron-deficient young women aren’t anemic. In US females aged 12 to 21, 38.6% were iron deficient at ferritin <25. So only 6.3% had iron deficiency anemia. Put another way, just 16.4% of the iron-deficient girls had become anemic. A CBC alone misses about 5 out of 6 of these ladies. Womp womp. Get this - 27% of girls who hadn’t started their periods were already iron deficient. Menstruation clearly adds risk, but it isn’t the whole story. This number came from the same JAMA analysis. And what ferritin number is considered "iron deficient?" Well, where you set the ferritin cutoff changes the prevalence by 4x! In the same group of young women, about 17% were deficient at ferritin <15, 38.6% at <25, and 77.5% at <50. The patients don’t change. Only the definition does. Here's the other problem... The classic "fatigue" workups in most clinics usually skip ferritin. In fact, in many HRT clinics, I often find providers attempting to solve for fatigue with HRT (great idea) but often fail and fall short if iron deficiency is the culprit. Iron helps fatigue even with a normal hemoglobin. In an RCT of non-anemic menstruating women with ferritin <50, oral iron cut fatigue scores by about 48%, compared with 29% on placebo (Vaucher et al., 2012). See how much this matters? Now, I can't possibly give all the nuance around iron, ferritin, thyroid, and even dosing and administration of iron here. So I took it a step further and recorded a whole podcast episode just for you :) If you're ready to watch, or listen, check it out for free on YouTube, Spotify, and Apple Podcasts. Hope this helps. -Nico PS If no one has said this to you in a while, you're doing a great job, and I'm really proud of you. References Vaucher, P., Druais, P.-L., Waldvogel, S., & Favrat, B. (2012). Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: A randomized controlled trial. CMAJ, 184(11), 1247–1254. https://doi.org/10.1503/cmaj.110950 Weyand, A. C., Chaitoff, A., Freed, G. L., Sholzberg, M., Choi, S. W., & McGann, P. T. (2023). Prevalence of iron deficiency and iron-deficiency anemia in US females aged 12–21 years. JAMA, 329(24), 2191–2193. https://doi.org/10.1001/jama.2023.8020 |
HRT University
Nurse practitioner, clinic owner, and founder of HRT University. I teach providers the physiology behind hormone therapy, so they’re not piecing it together on their own.
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