Ferritin 500 ng/mL in men — iron overload or inflammation?
A serum ferritin of 500 ng/mL in a man is above the typical reference range (30-400 ng/mL) and warrants differential diagnosis between two main causes: iron overload (where total body iron is genuinely elevated) and inflammation (where ferritin is acting as an acute-phase reactant). Iron overload is most commonly hereditary haemochromatosis (HFE C282Y homozygosity, present in ~1 in 200 of European-descent populations), but also occurs from repeated blood transfusions or excessive iron supplementation. Inflammation-driven ferritin elevation is far more common day-to-day — any infection, autoimmune flare, hepatic steatosis, or even recent intense exercise will transiently elevate ferritin. The differentiator is transferrin saturation: high in iron overload, low-normal or low in inflammation.
Reference ranges
| Standard reference — male | 30 – 400 ng/mL |
| Optimal target | 70 – 200 ng/mL |
| Mildly elevated | 400 – 1000 ng/mL |
| Significantly elevated | > 1000 ng/mL |
| Transferrin saturation — iron overload | > 45% |
| Transferrin saturation — inflammation | Often normal or low |
What this marker measures
Serum ferritin reflects intracellular ferritin (the iron-storage protein) that has leaked into circulation in proportion to total body iron stores. It's also an acute-phase reactant — IL-6 and other inflammatory signals upregulate ferritin synthesis independent of iron status. Transferrin saturation (% of iron-binding sites on transferrin that are occupied) better discriminates iron overload from inflammation: in iron overload, transferrin saturation rises in lockstep; in inflammation, transferrin itself drops as the acute-phase response shifts iron handling.
Why might it be elevated?
- ·Inflammation (most common cause day-to-day)
- ·Hereditary haemochromatosis (HFE C282Y mutation)
- ·Repeated blood transfusions
- ·Excessive iron supplementation
- ·Liver disease — hepatic steatosis, alcoholic liver, viral hepatitis
- ·Metabolic syndrome (drives both inflammation AND mild iron retention)
- ·Recent intense exercise
- ·Cancer (rarely; check broader workup)
Why might it be low?
- ·Iron deficiency (most common cause)
- ·See /learn/ferritin-30-women
FAQ
Should I get genetic testing?+
If ferritin >400 with elevated transferrin saturation (>45%) on multiple draws, HFE genotyping is the standard next step. C282Y homozygotes have a clinical risk of iron overload accumulating to organ damage over decades — the treatment is therapeutic phlebotomy (giving blood). Heterozygotes are usually clinically silent.
Should I donate blood?+
If your iron is elevated, blood donation is the simplest intervention — each donation removes ~250 mg of iron, equivalent to several months of dietary intake. For confirmed haemochromatosis, regular phlebotomy is the standard treatment.
This page describes biomarker research and reference ranges for self-tracking and research-context discussion only. It is not medical advice, not a diagnosis, and not a substitute for a qualified physician. Take any concerns about your health to a clinician.
Have your own panel? Read it next to the standard reference ranges with our free analyse tool.
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