Osteoarthritis is a disease marked by progressive and irreversible hyaline cartilage 25 and fibrocartilage breakdown that affects the lives of millions of patients worldwide. Female sex 26 and menopause are both risk factors for knee osteoarthritis, indicating that estrogen could play a 27 role in this disease. In this study, RNA sequencing was used to determine the effects of estrogen 28 treatment on human meniscal cells. Differences in the number and type of differentially expressed 29 genes were seen based on donor sex, estrogen dose, and dosing kinetics. Significantly more 30 differentially expressed genes were seen from male meniscal cells in response to all dosing 31 conditions compared to female cells. Importantly, more genes were differentially expressed in cells 32 treated with continuous dosing of estrogen, which has been shown to stimulate genomic estrogen 33 signaling, as compared to pulsed dosing. Additionally, functional enrichment analysis revealed 34 that many genes of the extracellular matrix, which is important for joint health and injury repair, 35were differentially expressed. Overall, this initial study lays the groundwork for future avenues to 36 pursue the effect of estrogen delivery on regenerative pathways. This critical analysis will then 37 inform the design and implementation of estrogen replacement therapies to promote meniscal 38 health and reduce the onset of osteoarthritis. 39 40