Anthropogenic noise continues to increase in aquatic environments and has been shown to have negative consequences on a fish’s ability to survive and reproduce. The effects of anthropogenic noise on fish are generally quantified using behavioral, physiological, or morphological metrics, and although transcriptional metrics are gaining in popularity, markers for noise specifically have not yet been determined. This review summarizes recent studies examining the transcriptional effects of various anthropogenic noise types on fishes. The majority of studies, primarily conducted in laboratory settings under varied conditions, report transcriptional alterations of genes involved in stress, immune function, metabolism, and neural development, with some species also exhibiting behavioral, physiological, and morphological responses to noise. Despite the variability in methodologies, study species, and sound sources, common functional pathways did emerge, highlighting stress, metabolic, and immune responses. The review emphasizes the need to continue using integrated approaches combining transcriptional, behavioral, and physiological metrics to better understand the long-term fitness consequences of noise-induced stress in fish. Future research should focus on incorporating conserved genetic markers across species and explore the potential cumulative effects of prolonged exposure to anthropogenic noise.