Functional changes to Achilles tendon and enthesis in an adolescent mouse model of testosterone hormone therapy.

PURPOSE/AIM: Some youth seek puberty suppression to prolong decision-making prior to starting hormone therapy to help align their physical sex characteristics with their gender identity. During peripubertal growth, connective tissues such as tendon rapidly adapt to applied mechanical loads (e.g. exercise) yet if and how tendon adaptation is influenced by sex and gender-affirming hormone therapy during growth remains unknown. The goal of this study was to understand how pubertal suppression followed by testosterone influences the structural and functional properties of the Achilles tendon using an established adolescent mouse model of testosterone hormone therapy. MATERIALS AND METHODS: C57BL/6N female mice were assigned at postnatal day 26 to the following experimental groups: control (vehicle treated), gonadotropin release hormone analogue (GnRHa) treatment alone to delay puberty, testosterone (T) alone after puberty, or delayed puberty with T treatment (i.e. GnRHa followed by T). RESULTS: We found that pubertal suppression using GnRHa with and without T, as well as treatment with T alone post-puberty, increased the ultimate load of tendon in female mice. Additionally, we found that GnRHa, but not T treatment resulted in a significant increase in cell density at the Achilles enthesis. CONCLUSIONS: These findings demonstrate that delayed puberty and T have no negative influence on structural or functional properties of mouse tendon.