• Alcohol is a frequently abused drug among adolescents. In adults, alcohol alters iron metabolism, predisposing to excess hepatic iron storage and, possibly, liver damage. The purpose of this study was to determine whether alcohol is associated with an elevated serum iron concentration and transferrin saturation in adolescents, and to determine the contribution of oral contraceptive use to these abnormalities. Adolescents (591 male and 614 female) aged 16 to 19 years, who participated in the first National Health and Nutrition Examination Survey from 1971 to 1973, were grouped according to their reported frequency of alcohol intake. Drinking frequency was associated with serum iron concentrations in boys and girls, and with total iron-binding capacity, transferrin saturation, and hemoglobin concentration in boys. Alcohol use was associated with an elevated serum iron concentration only in oral contraceptive nonusers. Adolescents who use alcohol have an elevated serum iron concentration, and male alcohol users have an increased transferrin saturation as well. These abnormalities may be precursors of hepatic iron overload and chronic liver damage.