The overall prevalence of liver disease ranged from 24% to 34%, higher than the 10% or lower reported for homozygous males in prior studies.9,13,26,27 This might be due to our broad definition of liver disease and the inability to separate HH-related liver disease from other causes of liver disease. The prevalence of liver cirrhosis in p.Cys282Tyr homozygous males was 4.5%, consistent with previous reports of 3.4%–5% in this population.27 The only liver-related phenotype that significantly differed between genotypes was the proportion of individuals who underwent liver biopsy, which was higher for homozygous females and males than for compound heterozygotes. A hypothesis for this difference is that the referral of individuals for liver biopsy happened after a suspicion of hemochromatosis was made on the basis of biochemical (i.e., abnormal iron studies) rater than clinical abnormalities.