I only had one transfusion, pre-splenectomy, 20 years ago. My hemoglobin has held steady my whole life between 8-10. So it has been solely from ingestion.
My docs were never really all too concerned about my iron load, since my bloodwork always showed elevated, but not extreme iron, which slowly crept up through the years (800, 900, 1000 etc).
I hadn't been feeling great so I switched docs last year - he sent me for the Liver MRI, which came back 350+, severe iron overload, so he put me on Jadenu right away.
Pretty interesting how high my iron went as a non-transfusional thal. But I had no idea and my previous doctors never seemed to be too concerned about it. I am very thankful for the doctor I have now, as well as the information available on the internet (including here!) I have adopted a lot of the information I have learned to really try to get my iron down as low as possible and raise my hemoglobin - wheat grass, IP-6, calcium, folic acid, etc.