We conduct a randomised control trial at an Italian university to investigate the impact of test anxiety on high-stakes exams. Students are subjected to two different interventions–silence and music–designed to influence their pre-test anxiety levels. We monitored and compared individual biomarkers before and after each treatment to measure anxiety changes and their influence on exam scores. Our findings revealed that decreased mean arterial and systolic pressures enhanced performance in females, particularly under the silence treatment. However, no significant effect was observed in male students. This study suggests that test anxiety could contribute to gender-based performance disparities.