Introduction: Heart rate variability (HRV) reflects autonomic nervous system (ANS) activity and emotional responsiveness. Music influences autonomic regulation through the heart–brain axis, yet sex-specific autonomic responses to different musical genres remain insufficiently characterized. Materials and methods: HRV parameters were recorded in 24 healthy young adults (17 females, 7 males; mean age 27.04 ± 1.97 years) at rest and during exposure to six musical genres: Baroque, Jazz, Heavy Metal, Romantic, Traditional Romanian, and Ambient. Time-domain and frequency-domain HRV parameters, including low frequency (LF), high frequency (HF), normalized LF (nLF), normalized HF(nHF), LF/HF ratio, and normalized coherence (NCoh), were analyzed. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS).Results: Heart rate did not differ between rest and musical sessions. In contrast, significant changes were observed in HRV parameters, particularly in the frequency domain. Compared with rest, nLF and LF/HF increased, and nHF decreased during all musical sessions, with more pronounced effects in males. Differences between musical genres were limited, whereas sex-related differences were consistent across sessions. rMSSD and HF were strongly correlated in all conditions except Jazz in males. LF/HF correlated directly with nLF and NCoh and inversely with nHF. Conclusion: Music modulates cardiac autonomic balance without altering heart rate. Autonomic responses are predominantly sex-dependent rather than genre-dependent, underscoring the importance of sex-specific analysis in studies investigating music-induced autonomic modulation.
