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If you’ve been following me on Instagram or tuning into my podcast lately, you’ve probably heard me talk about HTMA testing and how it’s transforming the way we support gymnasts. But what exactly is HTMA, and why should you care?
Hair Tissue Mineral Analysis (HTMA) is a powerful tool that measures mineral levels in the body by analyzing a small sample of hair. This test provides a long-term view of how minerals are being utilized, stored, and excreted—offering insights that traditional bloodwork often misses (PubMed).
For more information on how mineral balance affects gymnasts, listen to this episode about nutrient density + gymnasts and minerals.
Hair Tissue mineral analysis uses a human hair sample from the last 2-3 months of hair growth (about 1.5 inches from the root) to look at long-term mineral balance. This hair sample is sent off to an accredited laboratory (we only use Trace Elements as other labs do not handle the samples properly leading to inaccurate results). The lab runs the hair sample through mass spectrometry to look at mineral levels and comparative ratios, along with heavy metals as well.
A quick “google” of HTMA can pull up a research article that indicates HTMA is controversial.
Pros of HTMA
Reflects Long-Term Trends – Unlike blood tests, which show a snapshot in time, HTMA provides a 3-4 month view of mineral status and trends.
Non-Invasive & Cost-Effective – It’s an easy test to perform, requiring only a small hair sample.
Useful for Mineral Ratios – Key ratios (like Ca:Mg, Ca:P, Na:K) can indicate metabolic trends, adrenal function, and stress patterns.
Can Detect Heavy Metal Exposure – HTMA can reveal chronic exposure to toxic metals like lead, mercury, and aluminum.
Cons & Limitations
External Contamination – Shampoo, hair dye, and environmental factors can alter results. Labs typically wash the hair sample to minimize this, but not all do. This is why we only use Trace Elements Lab
Not a Direct Measure of Mineral Status – Hair mineral levels do not always correlate with blood levels. For example, high calcium in hair can mean low calcium inside cells (bio-unavailability). This is why we don’t use HTMA without also blood labs + in-depth dietary analysis.
Inter-Lab Variability – Different labs use different washing techniques and equipment, leading to potential discrepancies in results. This is why we only use Trace Elements who handle the hair samples properly and uphold the most rigorous testing process. All commercially operating laboratories in the United States is regulated under the Clinical Laboratory Improvement Amendments Act (CLIA).
HTMA (Hair Tissue Mineral Analysis) has been criticized, particularly in conventional medical circles.
These studies have been criticized for methodological flaws, such as improper sample collection and handling, which may have contributed to the variability in results. Proponents of Hair Tissue Mineral Analysis (HTMA) argue that when proper protocols are followed, HTMA can provide reliable information about mineral status and metabolic trends. For instance, laboratories like Analytical Research Labs (ARL) and Trace Elements, Inc. (TEI) emphasize not washing hair samples before analysis to prevent the loss of water-soluble elements, aiming to improve accuracy.
Criticism from Mainstream Medicine
You can read more here about HTMA Fact vs Fiction
So many of the gymnasts we work with are depleted in the major minerals involved in proper energy production, hormone regulation, and stress resilience. Most upper level competitive gymnasts have been training 20-30 hours a week for 5-10+ years and underfueling which puts them in a precarious spot and can lead to a lot of health issues that are not just coincidence.
Hair Tissue Mineral Analysis (HTMA) is a powerful tool for assessing metabolic function, adrenal health, and mineral balance by analyzing long-term mineral trends in the body. Key mineral ratios—such as calcium to magnesium (Ca/Mg) for blood sugar regulation, sodium to potassium (Na/K) for adrenal function, and zinc to copper (Zn/Cu) for immune and hormonal health—offer critical insights into metabolic efficiency. HTMA can also help identify slow vs. fast metabolism, thyroid imbalances (not medically diagnostic, but points to the key minerals involved), and iron recycling issues, particularly when paired with bloodwork like serum iron, ferritin, and ceruloplasmin. Additionally, HTMA detects toxic heavy metal exposure (lead, mercury, aluminum), which can interfere with nutrient absorption and energy production. While HTMA is not a standalone diagnostic tool, it is a valuable addition to lab testing for optimizing athlete performance, recovery, and nutrient metabolism.
We’ve been checking iron and vitamin D blood labs in gymnasts for years and have found that what we typically ask for doesn’t show the full picture of iron deficiency, mineral balance, and mobilization/recycling.
This is where integrating HTMA into our practice has been really helpful as this can give more of a long-term view of mineral balance versus just what is in the blood.
The body wants homeostasis, so blood levels of minerals often don’t reflect what is in tissue storage and if the body can access those stores.
Blood levels give us a snapshot of what levels are “in the moment” but HTMA can reveal long-term trends and patterns in your mineral status and toxic metal exposure, giving you deeper insights into your health history and future needs.
We love to do both blood work and HTMA with our gymnasts to get a comprehensive picture of what’s going on in their body so that we can adjust their nutrition and supplementation to best support their health, metabolism, recovery, and stress resiliency.
Each mineral plays a unique role in the body. Understanding these individual mineral levels helps pinpoint underlying health and performance issues for gymnasts.
Calcium & Bone Health in Female Athletes
Calcium is essential for bone strength, muscle contractions, and nerve signaling, making it a critical mineral for gymnasts and young female athletes. High calcium levels on HTMA can signal a sluggish metabolism, slow thyroid function, or a “calcium shell”, where excess calcium builds up in soft tissues instead of being properly utilized. Low calcium, on the other hand, is often linked to high stress, fast metabolism, and hyperactivity, which are common in elite-level athletes. When other minerals like magnesium, sodium, and potassium are depleted or imbalanced, calcium may not be directed properly into bones—raising the risk of stress fractures and other bone-related injuries in gymnasts. Optimizing mineral balance, dietary intake, and absorption is key to preventing these issues.
Magnesium: The Recovery & Performance Mineral
Magnesium is crucial for muscle relaxation, energy production, and stress resilience, yet many athletes are severely depleted intracellularly. Low magnesium levels contribute to muscle cramps, fatigue, poor recovery, and increased injury risk. Studies show that most gymnasts don’t even meet 50% of their daily magnesium needs, despite having higher requirements due to training stress and energy expenditure. High magnesium on HTMA can indicate poor absorption or a detox response as the body tries to excrete excess. We see gymnasts burning through really high amounts of magnesium leaving them really depleted at the cellular level (which also plays a big role in vitamin D absorption, etc). To enhance performance and recovery, gymnasts must prioritize magnesium-rich foods and supplementation when needed.
Sodium: The Adrenal & Hydration Spark Plug
Sodium is a key electrolyte for adrenal (stress hormone) function, hydration, digestion, and nerve signaling. It acts as one of the body’s major “spark plugs”, fueling energy and stress adaptation. Low sodium on HTMA is common in under-fueled, stressed gymnasts, especially those who avoid salt due to outdated nutrition myths (aka, afraid of being “bloated” or high blood pressure). Chronic low sodium is associated with “adrenal fatigue” (aka burnout), dehydration, and low energy levels, leading to burnout and poor performance. On the other hand, high sodium levels can indicate acute stress, inflammation, or adrenal overactivity. Proper sodium intake is critical for athletic performance, electrolyte balance, and recovery—especially for gymnasts training at high intensity.
Potassium: The Energy & Thyroid Regulator
Potassium is vital for nerve function, muscle contractions, and energy metabolism, yet many gymnasts show super low potassium levels on HTMA due to stress and poor intake. Low potassium is linked to fatigue, sluggish thyroid function, muscle weakness, and even acne and gut motility issues. High potassium may signal tissue breakdown or excessive mineral loss. Since potassium is another major “spark plug” mineral, it plays a direct role in muscle recovery, electrolyte balance, and overall endurance. Ensuring adequate potassium intake through diet and mineral support is crucial for gymnasts aiming to optimize their energy, performance, and resilience.
Copper & Iron Recycling in Female Athletes
Copper is essential for iron metabolism, hormone regulation, and immune function, making it a critical mineral for female athletes, gymnasts, and high-performance competitors. High copper levels are linked to estrogen dominance, anxiety, and impaired iron utilization, while low copper can contribute to anemia, immune weakness, and neurological issues. In Hair Tissue Mineral Analysis (HTMA), copper may appear elevated but bio-unavailable, meaning the body cannot efficiently use it for iron mobilization, red blood cell formation, and collagen production. Many female athletes diagnosed as iron deficient may instead (or in addition) have iron recycling and mobilization issues rather than a true deficiency.
To assess true copper status, it should be evaluated alongside ceruloplasmin, serum iron, zinc, and adrenal minerals like sodium, potassium, and magnesium. Instead of defaulting to iron supplementation, athletes should support copper metabolism, restore mineral balance, and optimize iron recycling pathways to enhance energy, endurance, and recovery.
Zinc: The Stress Resilience & Iron Recycling Mineral
Zinc plays a pivotal role in stress adaptation, immune defense, hormone regulation, and iron recycling, making it essential for female athletes’ recovery and performance. On HTMA, low zinc levels often indicate chronic stress, adrenal fatigue, gut dysfunction, or poor iron mobilization, while high zinc may reflect poor retention or mineral imbalance. The zinc-to-copper (Zn/Cu) ratio is especially important for hormonal balance, thyroid health, and oxidative stress regulation. Since zinc directly influences ceruloplasmin production, it also plays a role in how efficiently the body utilizes and recycles iron—a crucial factor for stamina, recovery, and oxygen transport.
To optimize zinc levels, athletes should assess plasma zinc, ceruloplasmin, and iron markers alongside HTMA and focus on whole-food mineral balance rather than excessive supplementation.
Boron: The Bone & Hormone Regulator
Boron is a key trace mineral for bone density, cognitive function, and hormonal balance. Low boron levels can impair calcium metabolism, leading to weaker bones, poor recovery, and reduced brain function—a concern for gymnasts and young female athletes prone to bone-related injuries. While high boron levels are rare, they may indicate a detoxification response to heavy metals. Maintaining optimal boron levels through diet and targeted supplementation supports strong bones, cognitive performance, and hormonal health.
Phosphorus: The Energy & Bone Strength Mineral
Phosphorus is vital for bone strength, ATP energy production, and overall metabolic health. Low phosphorus can signal inadequate protein intake or high stress, which can negatively affect muscle repair and endurance. Conversely, high phosphorus levels on HTMA may indicate increased metabolic demand, excessive muscle breakdown, or imbalanced calcium metabolism. Athletes should ensure adequate phosphorus intake from nutrient-dense sources to maintain strong bones, sustained energy, and optimal recovery.
Iron: Oxygen Transport & Endurance Performance
Iron is essential for oxygen transport, energy production, and endurance. Low iron levels can cause fatigue, dizziness, and poor stamina, which are common concerns for female athletes with heavy training loads. However, high iron levels may indicate absorption issues, inflammation, or copper imbalance, rather than true excess.
Since iron metabolism depends on copper and ceruloplasmin, assessing iron status alongside key minerals is crucial before supplementing. Instead of immediately turning to iron supplements, athletes should focus on supporting iron recycling pathways through proper copper balance, vitamin A intake, and adrenal support to ensure optimal performance and recovery.
By understanding these mineral levels and their interactions, we can use HTMA to develop personalized nutrition and supplementation strategies to enhance a gymnast’s performance, recovery, and overall health.
Each mineral plays a unique role in the body. Understanding these individual mineral levels helps pinpoint underlying health and performance issues for gymnasts.
HTMA doesn’t just provide data on individual mineral levels; it also gives insight into key mineral ratios, which can tell us more about metabolic function, stress response, and overall health. These ratios help practitioners identify imbalances that might not be obvious through standard bloodwork.
Key Mineral Ratios in HTMA Testing:
The 7 Key HTMA Ratios Used by Trace Elements & Their Impact on Female Athletes
1. Calcium/Phosphorus (Ca/P) Ratio: Metabolic Rate & Nervous System Balance
The Ca/P ratio is a fundamental marker of metabolic speed and nervous system function:
Balancing calcium and phosphorus intake through adequate protein, fats, and whole-food minerals can help regulate metabolic efficiency.
2. Sodium/Potassium (Na/K) Ratio: Adrenal Function & Stress Adaptation
The Na/K ratio is considered the “stress ratio,” reflecting adrenal health, inflammation, and overall resilience to stress:
Because sodium and potassium are critical for electrolyte balance and recovery, proper intake is vital for hydration, muscle contractions, and adrenal support in female athletes.
3. Calcium/Magnesium (Ca/Mg) Ratio: Blood Sugar Regulation & Bone Health
The Ca/Mg ratio is key for insulin regulation, glucose metabolism, and musculoskeletal health:
Since calcium is needed for insulin release and magnesium supports insulin sensitivity, maintaining a balanced ratio helps stabilize blood sugar for sustained athletic performance.
4. Zinc/Copper (Zn/Cu) Ratio: Hormone Balance & Mental Health
This ratio is critical for immune function, hormonal balance, and emotional well-being:
Since copper is tied to estrogen and zinc supports progesterone production, this ratio plays a major role in menstrual health, iron metabolism, and recovery from training stress.
5. Iron/Copper (Fe/Cu) Ratio: Oxygen Transport & Immune Function
The Fe/Cu ratio reveals how well iron is being utilized for energy production and oxygen transport:
Since iron metabolism depends on ceruloplasmin and copper bioavailability, this ratio must be assessed alongside bloodwork (serum iron, ferritin, and ceruloplasmin) to confirm iron status before supplementation.
6. Calcium/Potassium (Ca/K) Ratio: Thyroid Function & Metabolic Rate
The Ca/K ratio serves as a marker for thyroid function and energy regulation:
Since potassium enhances thyroid hormone uptake, low levels can mimic hypothyroid symptoms even when T3/T4 levels appear normal on bloodwork.
7. Sodium/Magnesium (Na/Mg) Ratio: Adrenal Output & Energy Reserves
The Na/Mg ratio provides insight into adrenal activity and overall energy production:
Because aldosterone regulates sodium retention, this ratio reveals whether an athlete is in a high-stress response mode or experiencing adrenal exhaustion.
Why These 7 Ratios Matter for Gymnasts
For a gymnast, these HTMA ratios provide valuable insights into metabolism, stress adaptation, adrenal health, and recovery potential. By balancing minerals through diet, supplementation, and lifestyle adjustments, gymnasts can optimize endurance, prevent burnout, and support long-term performance.
1. Bone Health & Injury Prevention
Stress fractures, stress reactions, and growth plate injuries are all too common in gymnasts. HTMA helps reveal deficiencies in bone-supporting minerals like magnesium, calcium, and phosphorus, allowing for targeted nutritional interventions before injuries occur (PubMed).
2. HTMA & Iron Deficiency in Female Athletes: Looking Beyond Ferritin
Many female athletes struggle with low ferritin, but standard iron panels often miss what’s really happening with iron metabolism. Simply supplementing with iron isn’t always the answer—mineral imbalances, poor iron recycling, and blocked absorption can play a major role.
HTMA, paired with targeted bloodwork, helps uncover hidden factors that impact iron status, such as: Bio-unavailable copper that interferes with iron absorption
High calcium levels that disrupt iron metabolism
**Ceruloplasmin’s role in iron mobilization and oxygen transport
Rather than guessing, our approach goes beyond conventional testing to assess whether an athlete truly needs iron or if the issue lies in iron recycling and bioavailability.
Want to know if your gymnast is absorbing and using iron properly? Our iron metabolism method pinpoints what’s really happening at the cellular level for optimal endurance, recovery, and performance.
3. Headaches & Migraines
Frequent headaches and migraines are often linked to mineral imbalances, particularly low magnesium, sodium, and potassium levels, which affect nerve signaling, hydration, and muscle tension. Magnesium deficiency can lead to vasoconstriction and poor stress resilience, while electrolyte imbalances contribute to dehydration and adrenal dysfunction, common triggers for migraines.
HTMA provides a long-term view of mineral status, helping to identify underlying deficiencies that may be contributing to headaches. With targeted mineral support, athletes can optimize hydration, reduce tension, and improve headache frequency and severity.
4. Picky Eating & Nutrient Deficiencies
Picky eating isn’t just a preference—it can be influenced by mineral imbalances that impact appetite, taste perception, and digestion. Low zinc reduces taste sensitivity and appetite, low magnesium contributes to anxiety and gut issues, and high calcium with low magnesium can increase food aversions. Electrolyte imbalances (sodium & potassium) also affect energy levels and hunger cues.
HTMA helps pinpoint these deficiencies, guiding a targeted nutrition approach to expand food variety, improve appetite, and support optimal energy, recovery, and performance for gymnasts.
5. PMS, Heavy Periods & Hormonal Imbalances in Gymnasts: How HTMA Can Help
Painful cramps, heavy periods, and hormonal imbalances are common struggles for gymnasts, often made worse by mineral deficiencies and imbalances. Since hormones and minerals work together, disruptions in copper, magnesium, and zinc levels can contribute to estrogen dominance, inflammation, and painful cycles.
What HTMA Can Reveal About Period Health for a gymnast
Bio-Unavailable Copper & Estrogen Dominance
Low Magnesium & Painful Cramps
Zinc Deficiency & Increased Inflammation
6. Chronic Fatigue & Poor Recovery
Even with adequate fueling, some gymnasts experience persistent fatigue. HTMA can reveal if minerals like magnesium, sodium, and potassium are out of balance, impacting energy levels and recovery.
7. Toxic Metal Exposure & Its Impact on Health
HTMA can detect toxic heavy metals like mercury, lead, and aluminum that may have accumulated in the body. These toxins can interfere with energy production, immune function, and even cognitive performance. Addressing these exposures through strategic nutrition and detoxification support can significantly improve a gymnast’s well-being.
We integrate HTMA testing into our TBG® Program when bloodwork and standard interventions aren’t yielding results. Some scenarios where HTMA has been a game-changer:
For some gymnasts, HTMA helps fill in the gaps when traditional methods don’t explain ongoing symptoms. For others, it’s a way to fine-tune their nutrition to maximize their strength, endurance, and recovery.
1. Gymnast Resistant to Iron Supplementation
We had an 11 year old level 6 competitive gymnast who struggled with chronically low ferritin despite taking iron supplements. She’d come to our practice due to ongoing fatigue and poor energy levels, having already had the pediatrician run labs. Her initial bloodwork showed low ferritin and increased iron binding capacity with low MCV which fit the clinical picture of iron deficiency without anemia. She started on iron bisglyciante and after 3 mothof supplementation, her ferritin levels didn’t change. After another 3 months, ensuring compliance, her levels remained unchanged. She had a history of being a selective eater and vegetarian. Her HTMA revealed high levels of biounavailable copper and really depleted electrolytes that were preventing proper iron mobilization and recycling. Once we put her on the right minerals, her ferritin level tripled within 6 weeks and all her fatigue symptoms resolved.
2. Gymnast with Hormonal & Skin Issues
We had a 15 year old level 9 gymnast who had started menstruation a year ago and with that can severe premenstrual nausea, vomiting, and cramps (plus acne). The chiropractor had put her on several supplements to try and help but no avail (vitex, magnesium, omegas, iron, vitamin D, calcium). HTMA testing showed several markers of copper dysregulation with a stress pattern of mineral depletion. We put her on custom minerals and within 6 weeks her first cycle while on the right minerals was almost 100% symptom free. Months later she continues to do well with easy, manageable periods (when previously she’d ended up in the ER due to such severe PMS symptoms that were thought to be appendicitis or food poisiong). As an added benefit, her acne has also significantly cleared up which is related to mobilizing that biounavaiblle copper and repleting the minerals needed for the skin.
3. High-Performing Gymnast Looking for an Edge
We do HTMA for a lot of our level 10 and elite gymnasts who we know have 8-10+ year history of underfueling, stress, and ultimately mineral depletion. Many of them make incredible performance improvements when we first optimize their nutrition and endure adequate energy availability. But, enough calories doesn’t guarantee adequate minerals or that the minerals can get where they need to go in the body.
Many of our high-level gymnasts have a very similar stress depletion pattern and feel so much better physically and mentally when we balance their minerals while taking into account their lab work. They have more energy, better focus, better periods/skin, better endurance, and all of that translates to less burnout and more resilience.
HTMA testing is a powerful, underutilized tool for gymnasts looking to optimize their health, recovery, and performance. By identifying mineral imbalances and toxic element exposures, we can create targeted strategies to support energy levels, injury prevention, and overall well-being.
If you want to learn more or do HTMA testing with your gymnast, this is something available to our 1:1 clients inside The Balanced Gymnast® Program.
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