Dr Cory Dugan

Our randomised controlled trial explored whether intravenous iron improves exercise performance and fatigue in iron-deficient, non-anaemic women.

Twenty-six participants received either a single 1000 mg infusion or a placebo.

One finding sits underneath the headline results. At four weeks, serum ferritin across the women who received iron ranged from 73 to 508 µg/L, from the same fixed dose.

Every participant who received iron responded. The magnitude of that response varied considerably.

A group mean describes the group. It does not describe the individual in front of you.

Dugan et al., Br J Sports Med 2025;59(13):921-930.

Educational content, not individual medical advice.

The research on iron deficiency in women is everywhere. It just does not reach the women living with it.

Every week there are women whose test came back "normal" while they were running on empty, because what explains that never makes it out of the journals.

So the work now is translation: turning what the evidence already shows into something you can actually use, and into better screening for the workplaces where it is missed most.

The research, translated: https://drcorydugan.com/iron-protocol

Educational content, not individual medical advice.

A full blood count can read normal while your iron stores are already empty. So if you are having bloods done, these are the ones worth asking for by name. Ferritin is the earliest marker of low iron, and CRP checks that a normal-looking ferritin is not just inflammation in disguise. One extra box can turn a normal result into a real answer. Educational content, not individual medical advice.

You were told your bloods are normal. You are still exhausted. Iron deficiency rarely announces itself. It can hide as fatigue that sleep does not fix, brain fog, hair shedding, brittle nails, ice cravings, restless legs. These are some of the common signs, and there are many more. If any of them feel familiar, it can be worth looking further than haemoglobin. Which of these do you recognise, and what would you add? Tell me in the comments. Educational content, not individual medical advice.

New podcast episode. I sat down with Chris Newport on Find Your Edge to talk iron deficiency in endurance athletes: why it gets missed, how to test for it properly, and what to do about it.

A normal haemoglobin can hide low iron for months. If you train hard and feel flat, have a listen.

https://podcasts.apple.com/au/podcast/iron-deficiency-in-endurance-athletes-signs-testing/id1513370052?i=1000775123765

A few years ago we ran the IRONWOMAN trial: a double-blind, randomised controlled trial of intravenous iron in 26 recreationally active women who were iron deficient but not anaemic. It was published in the British Journal of Sports Medicine last year.

The interesting part was not just that iron helped. It was what it helped, and what it did not.

Over four weeks, iron status improved, running economy improved, and fatigue scores came down. Aerobic capacity, haemoglobin mass and mood did not change.

The split is the part I keep coming back to. Iron deficiency and low mood often travel together, so it is tempting to assume that correcting one corrects the other. Here, restoring iron eased the fatigue and improved running economy, but mood did not move, which suggests it was carrying something iron alone could not explain.

The takeaway for anyone in women's health: iron deficiency is common, treatable, and worth measuring properly, but it is one piece of a bigger picture, not the whole story.