“Your Labs Are Normal”
Before I ever knew what ferritin was, before I understood iron studies or anemia, I knew something wasn't right.
At 23 years old, I started losing clumps of hair.
Not strands.
Clumps.
My ponytail, which once took two hands to hold while I twisted it into an elastic, was rapidly shrinking. Every shower felt like a reminder that something was changing, and not for the better. At the same time, I was gaining weight despite waking up every morning at 5:30 a.m. to run three miles before work.
I was doing everything I had been told was supposed to work.
I exercised.
I watched what I ate.
I restricted calories.
Yet my body seemed determined to move in the opposite direction.
Eventually, I scheduled an appointment with a primary care provider.
"Something feels off," I told him. "I'm losing hair rapidly, and despite running every day and watching what I eat, I'm gaining weight."
He ordered lab work and an ultrasound.
At my follow-up appointment, he reviewed the results and said, "Your thyroid looks normal. You don't have ovarian cysts. You're overweight and need to lose weight."
I blinked at him in disbelief.
"Did you hear me say I calorie restrict and get up every morning to run three miles?"
He shrugged.
"Keep it up. Your labs are normal. There's nothing to indicate anything is wrong."
I remember leaving that appointment confused.
On paper, I was healthy.
But I didn't feel healthy. My hair was falling out. My weight was increasing despite significant effort. My intuition was telling me something wasn't right. Yet because my lab values fell within a reference range, the conversation ended there.
Looking back, that was the first time I encountered the difference between normal and optimal. At the time, I didn't know those were two very different things.
So I did what I thought I was supposed to do.
I cleaned up my diet even more.
I kept running.
I kept restricting calories.
My hair continued falling out.
The weight wouldn't budge.
And eventually, I began accepting that maybe this was simply my body.
Seven years later, I was still losing hair. The weight was still stubborn. I was sleeping eight to nine hours every night and waking up exhausted.
This time, I saw an integrative provider.
She ordered a CBC and ferritin.
At my follow-up appointment, she told me, "You have mild anemia."
My ferritin was 12.
She explained that I could pursue iron infusions, but insurance often wouldn't cover them, or I could try oral iron, which can be difficult for some people to absorb and tolerate. She also suggested that perhaps some of my fatigue was emotional.
Maybe I was stressed.
Maybe counseling would help.
Maybe chiropractic care would help.
At the time, I didn't fully understand what ferritin represented. I didn't know ferritin was essentially my body's iron reserve account. I didn't know that iron deficiency can exist long before someone is officially classified as anemic. I didn't know that many women experience symptoms for years while their bodies slowly deplete iron stores in an effort to keep hemoglobin levels afloat.
Most importantly, I didn't know enough to ask better questions.
So life went on.
I accepted the explanation.
I assumed my symptoms were simply part of getting older. I watched my sister in her 20’s work out and accomplish difficulties so seamlessly, and remembered being 20 with fondness. I mean, this is the normal part of aging right?
I continued pushing through.
Then another decade passed.
The fatigue became impossible to ignore.
Walking up stairs left me breathless.
Exercise became harder.
Recovery took longer.
My energy disappeared.
Symptoms accumulated that I couldn't explain.
Things that once felt effortless suddenly felt difficult.
I eventually purchased a CBC, ferritin, iron panel, and additional labs through The Wellness Lounge Lab Shop. That same day I had my blood drawn at Quest and the results began arriving the following day.
My ferritin was 3.
Three.
Not 30.
Not 13.
Three.
My hemoglobin was severely low.
My serum iron was low.
My iron saturation was low.
For the first time in nearly two decades, I wasn't looking at isolated symptoms anymore.
I was looking at a pattern that had accumulated over time and become systemic.
Suddenly the hair loss made sense.
The breathlessness made sense.
The exercise intolerance made sense.
The overwhelming fatigue made sense.
The feeling that I was somehow working harder than everyone around me just to maintain basic function made sense.
For years I had blamed myself.
I thought I wasn't disciplined enough.
I thought I wasn't exercising hard enough.
I thought I wasn't eating well enough.
What I eventually discovered was that my body had likely been compensating for a significant deficiency for years. I'm not sharing this because iron deficiency is the answer for everyone. There are many reasons women lose hair, gain weight, struggle with energy, or feel exhausted.
But I am sharing it because I wonder how many women have been told their labs are "normal" without anyone explaining what those numbers actually mean.
How many women have been told to eat less and exercise more when their bodies were waving a flag that something deeper was happening?
How many women have ferritin levels that technically fall within a laboratory reference range but are nowhere near optimal for how they feel?
And how many women have never had their ferritin checked at all?
One of the most overlooked realities in women's health is that women lose blood every month. Every month blood is lost and every month iron is lost. Depending on the severity of that blood loss, some women may never fully replenish their iron stores. Over years and decades, those reserves can slowly decline until symptoms become impossible to ignore.
Approximately 30-40% of reproductive-age women report heavy menstrual bleeding (HMB) at some point in their lives.
About 10-30% of women with heavy menstrual bleeding develop iron deficiency anemia.
An even larger percentage, often 40-60%, develop iron deficiency without anemia, meaning their ferritin becomes depleted long before hemoglobin falls.
Studies of women presenting with heavy menstrual bleeding have found iron deficiency rates as high as 50-70% depending on the ferritin cutoff used.
Looking back, it is difficult not to wonder how long my body had been compensating.
Hair loss was one of the earliest signs.
Then came the stubborn weight gain.
Then the declining exercise performance.
Then the fatigue.
Then the breathlessness.
Iron deficiency rarely develops overnight.
For many women, it is a slow process that unfolds over years as iron losses gradually exceed iron replacement. By the time my ferritin reached 3, my body had likely been operating with depleted reserves for a very long time.
Understanding CBC (Complete Blood Count)
A CBC helps us understand how effectively your blood is carrying oxygen throughout the body. Think of your red blood cells as delivery trucks responsible for transporting oxygen to every organ, tissue, and muscle.
Hemoglobin (Hgb)
What it is: Hemoglobin is the oxygen-carrying protein inside your red blood cells. If red blood cells are delivery trucks, hemoglobin is the cargo carrying oxygen throughout your body.
When it's low, you may experience:
Fatigue
Shortness of breath
Dizziness
Exercise intolerance
Heart palpitations
Reduced endurance
Hemoglobin is often one of the last iron-related markers to become abnormal. Your body will sacrifice iron stores (ferritin) for years in an effort to maintain hemoglobin production. CBC is typically one of the labs your conventional provider will run. However, we believe they’re looking out of order, at the last indicator to fall before the results of severe anemia.
This is one reason many women experience symptoms long before they are officially diagnosed with anemia.
Optimal range (women): 13.5-15.0 g/dL
Hematocrit (Hct)
What it is: Hematocrit measures the percentage of your blood volume made up of red blood cells. If you poured your blood into a measuring cup, hematocrit tells you how much of that cup is occupied by oxygen-carrying cells.
When it's low:
Reduced oxygen delivery
Fatigue
Often mirrors anemia
Optimal range (women): 38-45%
MCV (Mean Corpuscular Volume)
What it is: MCV measures the average size of your red blood cells. Think of this as the size of your oxygen delivery trucks.
When MCV is low:
Often suggests iron deficiency
Red blood cells become smaller because there isn't enough iron available to build them properly
Optimal range: 85-95 fL
MCH (Mean Corpuscular Hemoglobin)
What it is: MCH measures how much hemoglobin is packed into each red blood cell. In other words, how much oxygen cargo each truck can carry.
When MCH is low:
Less oxygen is delivered with each red blood cell
Often accompanies iron deficiency
Optimal range: 28-32 pg
RDW (Red Cell Distribution Width)
What it is: RDW measures variation in red blood cell size. A healthy fleet of delivery trucks is relatively uniform in size. RDW tells us whether some trucks are tiny while others are oversized.
When RDW is elevated:
Often one of the earliest signs of iron deficiency
Indicates the body is struggling to consistently produce healthy red blood cells
Optimal range: 11.5-13.5%
Understanding Your Iron Panel
While a CBC tells us how oxygen is being delivered, an iron panel tells us about your iron reserves and transportation system.
Ferritin
What it is: Ferritin is your iron storage protein. Think of ferritin as your body's savings account.
Ferritin reflects how much iron you have stored away for future use. When iron intake or absorption cannot keep up with demand, your body begins withdrawing from these reserves.
Your body will drain ferritin long before hemoglobin begins to fall. This is why many women can experience symptoms for years without technically being classified as anemic.
Common symptoms of low ferritin:
Hair loss
Fatigue
Brain fog
Poor exercise recovery
Restless legs
Cold intolerance
Increased hunger and appetite
Reduced endurance
Conventional deficiency: Less than 15-30 ng/mL
Many functional and hair restoration providers target: 70-100 ng/mL
Serum Iron
What it is: Serum iron measures the amount of iron currently circulating in your bloodstream. Think of this as the cash currently in your wallet.
Unlike ferritin, serum iron can fluctuate throughout the day depending on food intake, inflammation, and absorption.
Optimal range: 90-120 mcg/dL
Transferrin
What it is: Transferrin is the protein responsible for transporting iron throughout the body. These are your delivery trucks.
When iron becomes scarce, the liver often produces more transferrin in an attempt to capture every available molecule of iron.
High transferrin may suggest:
Iron deficiency
Increased iron demand
Low iron intake
Increased blood loss
Optimal range: 250-300 mg/dL
TIBC (Total Iron Binding Capacity)
What it is: TIBC measures how much iron your transferrin could potentially carry. Think of this as the number of empty seats available in your delivery trucks.
High TIBC suggests:
Plenty of empty carrying capacity
Not enough iron available to fill those spaces
Commonly seen in iron deficiency
Optimal range: 300-360 mcg/dL
Iron Saturation (% Saturation)
What it is: Iron saturation tells us what percentage of transferrin is actually carrying iron. In other words, how full your delivery trucks are.
For example:
40% saturation = trucks are reasonably full
10% saturation = trucks are mostly empty
This is often one of the best indicators of whether your tissues are actually receiving adequate iron.
Optimal range: 25-40%
The Typical Progression of Iron Deficiency
In many women, iron deficiency develops gradually:
Ferritin falls first (the savings account begins to empty).
Transferrin and TIBC increase (the body sends out more empty trucks).
Iron saturation falls (fewer trucks are carrying cargo).
Serum iron falls.
MCV and MCH decline (smaller trucks carrying less cargo).
Hemoglobin eventually drops.
Iron deficiency anemia develops.
By the time hemoglobin becomes abnormal, iron depletion has often been present for months or years.
Common Causes of Iron Deficiency in Women
Iron deficiency is a symptom, not a diagnosis. The most important question is always: Why are these numbers low?
Common contributors include:
Heavy menstrual bleeding
Large menstrual clots
Endometriosis
Adenomyosis
Fibroids
Pregnancy and postpartum recovery
Low dietary iron intake
Vegetarian or vegan diets
Eating disorders
Celiac disease
Gastritis
H. pylori infection
Inflammatory bowel disease
Chronic inflammation
Autoimmune disease
B12 deficiency
Folate deficiency
Copper deficiency
Gastrointestinal bleeding
Excessive cardio
The root cause could be a combination of issues.
The goal should never be simply raising iron levels. The goal is identifying and addressing the underlying cause while safely restoring iron stores.
Today, after my own experience, I believe women deserve better conversations about their health.
I believe ferritin, CBCs, and iron studies should be discussed more often, especially for women experiencing fatigue, hair loss, heavy menstrual bleeding, exercise intolerance, shortness of breath, restless legs, or unexplained symptoms.
I believe patients deserve providers who listen to their lived experience and investigate when symptoms do not match the story the lab report appears to tell.
At The Wellness Lounge, that is our commitment.
When you tell us something feels off, we listen. When symptoms persist, we keep asking questions. When lab work looks "normal," we dig deeper to understand whether it is truly optimal for you.
Because our goal is not average.
Our goal is helping people feel their best.
Looking back, I do not wish someone had simply told me my labs were normal. I wish someone had taught me how to understand them. I wish someone had explained the difference between being free of disease and functioning optimally. I wish someone had looked beyond the reference range and asked a simple question:
"How do you actually feel?"
Because despite being told my labs were normal, I was losing hair.
I was gaining weight despite consistent exercise.
I was exhausted.
I was struggling.
And most importantly, I knew something was wrong.
My ferritin was 3 before I finally found answers.
I often wonder how different the last twenty years might have looked if someone had taken those early warning signs seriously.
I’m thankful for to know and understand, and now that is one of my primary aims via The Wellness Lounge. Is to help educate women what optimal looks like for them, and work to achieve that. I’m on the journey to achieving optimal health and resolving root cause issues.
You can order your labs through our Labshop here. We recommend ordering the Iron, TIBC, Ferritin panel, include a CBC, B12 & Folate, Sed Rate Modified by Westegren, CRP, Thyroid, and TPO if you’re curious about where you sit today.
Then set up your diagnostic consult with one of our providers here.
You can schedule your venofer infusion here. We do need a copy of the above labs to begin your venofer infusions as our protocols are customized to your specific needs.
References
Camaschella C. Iron Deficiency. New England Journal of Medicine. 2015;372(19):1832-1843.
Auerbach M, Adamson JW. How we diagnose and treat iron deficiency anemia. Blood. 2016;128(17):2101-2109.
World Health Organization. Iron Deficiency Anaemia: Assessment, Prevention and Control.
Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. Journal of the American Academy of Dermatology. 2006;54(5):824-844.
American College of Obstetricians and Gynecologists (ACOG). Screening and Management of Bleeding Disorders in Adolescents With Heavy Menstrual Bleeding.