Background <p>Music performance anxiety (MPA) is a multidimensional and multicausal phenomenon that inevitably affects musicians throughout their careers. Tertiary student pianists are more highly susceptible than professional pianists to MPA-induced physical and psychological distress. Owing to their limited experience in performance and onstage, MPA is more likely to exert negative impacts on their performing careers. This study aims to adopt a qualitative approach to investigate tertiary student pianists’ MPA-related experiences from their perspectives.</p> Methods <p>Data were collected via semi-structured one-on-one interviews with 27 student pianists from nine higher education institutions in China. Reflexive thematic analysis was conducted to analyse the data, adhering to the framework proposed by Braun and Clarke (2006).</p> Results <p>Through thematic analysis, six themes regarding tertiary student pianists’ MPA-related experiences were identified: (1) timing and stages of MPA emergence, (2) physical sensations and symptoms, (3) psychological thoughts and feelings, (4) social relational supports and hindrances, (5) positive and negative impacts of MPA, and (6) reconciliation with MPA.</p> Conclusion <p>This study delves deeply into tertiary student pianists’ subjective experiences related to Music Performance Anxiety (MPA), as well as their true thoughts and psychological journeys. This study offers insights for the public and seeks to enhance understanding of tertiary student pianists’ experiences. It specifically highlights the perspectives of young East Asian pianists within the context of musicians’ mental health research, aiming to elicit greater attention, assistance, and support for these students from all sectors of society.</p>