09/30/2026
🩸The American Society of Hematology (ASH) recently released updated clinical diagnostic guidelines for iron deficiency. Additional guidance on treatment is expected to be released in 2027🩸
While this is a step in the right direction, these guidelines are just that - guidelines meant for a wide population, not necessarily specific to athletes who likely have higher thresholds due to a given number of risk factors considered in this post.
These new guidelines give clinicians a strong framework to detect iron deficiency earlier. This update gives us better guidance for recognizing when iron stores are too low in populations that are at greater risk: menstruating individuals (especially women with heavy menstrual bleeding, pregnancy planning, additional risk factors), pregnant individuals and adults with inflammation (which covers a broad spectrum).
Iron is a key micronutrient with roles in red blood cell production, DNA replication, energy production in the mitochondria and neurotransmitter synthesis. Iron deficiency is common and affects individuals across the lifespan.
Iron status is important for athletes due to its roles in transporting oxygen specifically to working/recovering muscles and supports energy metabolism by helping mitochondria produce energy (ATP) needed during exercise.
Proper screening, interpretation, treatment, supplementation and individualized performance implications remain relevant specifically for young athletes, menstruating female athletes, endurance athletes, athletes with low energy availability, athletes who follow restrictive or selective diets and pregnant athletes.
Why does this matter?
Iron is necessary for transporting oxygen throughout the body. Iron deficiency is important to detect before an athlete develops iron-deficiency anemia.
Young, female, endurance athletes tend to have more risk factors of iron deficiency due to increased energy requirements, potential inadequate intake and training-related impact on iron metabolism. Notable risk factors commonly seen are low energy availability, high training loads, loss or or irregular menstrual cycles, GI issues, elevated inflammation, etc.
Identifying iron deficiency c