Impact of one HF-rTMS session over the DLPFC and motor cortex on acute hormone dynamics and emotional state in healthy adults: a sham-controlled pilot study

Abstract

Studies indicate that high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) can lower cortisol concentration or output, with some evidence suggesting a link to testosterone. Together, these stress and social hormones might help regulate the emotional response to HF-rTMS. This pilot study evaluated the effect of HF-rTMS on acute testosterone and cortisol dynamics and emotional state in eleven healthy adults. Using a sham-controlled, single-blind, crossover design, participants completed a HF-rTMS session targeting the dorsolateral prefrontal cortex (DLPFC) and motor cortex on separate days. Stimulation (250 total pulses) was applied at 90% of the resting motor threshold. Salivary testosterone and cortisol, mood, motivation, anxiety, and heart rate (HR) were assessed before (T₁) and 1 (T₂), 15 (T₃), and 30 min (T₄) after each session. There were no significant session differences in testosterone and cortisol concentration, mood, motivation, and HR. Although DLPFC stimulation produced less anxiety (vs. motor cortex), and testosterone output was stable across both treatments (vs. sham-related decline in testosterone), neither differed from the sham. Within-person fluctuations in testosterone, mood, motivation, and/or anxiety were significantly related across the DLPFC and motor cortex trials only. In conclusion, a single sub-maximal session of HF-rTMS did not affect the hormonal, emotional, or physiological state of healthy adults, relative to a sham. However, the emergence of stimulation-specific testosterone and/or emotional linkages suggests that the repeated effects of HF-rTMS may also manifest at the individual level. This offers another pathway to explain the therapeutic efficacy of rTMS and a model to explore interindividual variability in health-related outcomes.