Why do I feel tired and have hair loss at 29 years?

Question

Hello doctor,

I am a 29-year-old unmarried female. Nowadays, I feel tired and also suffer from hair loss. So, I got my blood and urine tests done on the first day of my period. My test results are:

DHT (Dihydrotestosterone): 399.93 pg/mL.
DHEA–S: 132.6 µg/dL.
Iron: 28 µg/dL.
TIBC: 367 µg/dL.
Transferrin Saturation: 8 %.
Ferritin: 14.5 ng/mL.
UIBC: 338.4 µg/dL.
Vitamin B12: 473 pg/mL.
Total Cholesterol: 226 mg/dL.
HDL Cholesterol: 45 mg/dL.
LDL Cholesterol: 167.8 mg/dL.
Triglycerides: 71 mg/dL.
TC / HDL Ratio: 5.
Triglyceride / HDL Ratio: 1.58.
LDL / HDL Ratio: 3.7.
HDL / LDL Ratio: 0.27.
Non-HDL Cholesterol: 180.39 mg/dL.
VLDL Cholesterol: 14.28 mg/dL.
Alkaline Phosphatase: 81.6 U/L.
Total Bilirubin: 0.52 mg/dL.
Direct Bilirubin: 0.08 mg/dL.
Indirect Bilirubin: 0.44 mg/dL.
GGT: 19.7 U/L.
SGOT (AST): 20.1 U/L.
SGPT (ALT): 13.7 U/L.
SGOT / SGPT Ratio: 1.47.
Total Protein: 7.31 g/dL.
Albumin: 3.92 g/dL.
Globulin: 3.39 g/dL.
A/G Ratio: 1.16.
T3: 90 ng/dL.
T4: 6.38 µg/dL.
TSH: 1.93 µIU/mL.
FT3: 2.65 pg/mL.
FT4: 1.05 ng/dL.
Chloride: 107 mmol/L.
Sodium: 138.7 mmol/L.
Blood Urea Nitrogen (BUN): 8.62 mg/dL.
Creatinine: 0.59 mg/dL.
BUN / Creatinine Ratio: 14.61.
Urea: 18.45 mg/dL.
Calcium: 9.54 mg/dL.
Uric Acid: 3.9 mg/dL.
eGFR: 127 mL/min/1.73 m².
Vitamin D2: 0.51 ng/mL.
Vitamin D3: 28.21 ng/mL.
Total Vitamin D: 28.72 ng/mL.
HbA1c: 5.1 %.
Average Blood Glucose: 100 mg/dL.
ESR: 24 mm/hr.
Hemoglobin: 13.5 g/dL.
Hematocrit (PCV): 43.9 %.
RBC Count: 5.07 ×10⁶/µL.
MCV: 86.6 fL.
MCH: 26.6 pg.
MCHC: 30.8 g/dL.
RDW-SD: 41.7 fL.
RDW-CV: 13.4 %.
WBC Count: 7.89 ×10³/µL.
Platelet Count: 396 ×10³/µL.
Fasting Blood Sugar: 74.45 mg/dL.
Urine Colour: Pale Yellow.
Urine Appearance: Clear.
Specific Gravity: 1.015.
pH: 5.5.
Urine Protein: Absent.
Urine Sugar: Absent.
Urine Ketone: Absent.
Urine Blood: Present.
RBC in Urine: 5 / HPF.
Pus Cells: Absent.
Epithelial Cells: 5 / HPF.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have thoroughly gone through your reports. I understand how concerning fatigue and hair fall can be at this young age, and I will keep this explanation clear and concise.

According to your reports, your iron profile clearly shows iron deficiency:

Serum Iron: 28 µg/dL (low).
Ferritin: 14.5 ng/mL (low).
Transferrin saturation: 8 percent (low).
TIBC (total iron binding capacity): raised.
UIBC (unsaturated iron binding capacity): raised.

Even though your hemoglobin is currently normal, low ferritin indicates depleted iron stores, which commonly causes:

Fatigue and easy exhaustion.
Hair fall.
Breathlessness on exertion (like climbing stairs).

Another contributing factor is your vitamin D levels. Vitamin D insufficiency is present.

Total Vitamin D: 28.7 ng/mL.

This has also worsened your fatigue and hair fall.

Your thyroid profile is normal. DHT (dihydrotestosterone) is relatively high and may contribute to hair fall, but correction of iron deficiency is the priority.

Your low-density lipoprotein cholesterol and total cholesterol are elevated, so lifestyle modification is advised at this stage.

Urine findings show mild red blood cells, likely due to sample collection during menstruation, and are not concerning.

I would suggest the following measures:

Start oral iron supplementation for three to four months.
Take vitamin D supplementation as advised.
Ensure an iron- and protein-rich diet.
Hair fall should improve gradually over eight to twelve weeks after correction.
Repeat your laboratory reports of iron studies after three months.

This is a common and treatable condition in young women. With proper supplementation, your energy levels and hair fall should improve. The probable causes are a poor diet and a lack of supplements. No further investigations are required. Differential diagnosis includes thyroid disease, and the probable diagnosis is iron deficiency.

The treatment plan includes:

Iron supplementation with tablet Ferrous Sulphate 65 milligrams daily.
Tablet Vitamin C daily for three months.
Capsule Vitamin D 200000 international units twice monthly, fifteen days apart, only two capsules a month.
Preventive measures include avoiding fatty meals and high-carbohydrate content.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.