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Repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for language recovery in post-stroke aphasia, yet the efficacy of different frequency protocols remains to be fully understood. This study aims to explore the efficacy of high versus low-frequency rTMS on language recovery in post-stroke aphasia. In this retrospective cohort study, 194 patients with post-stroke aphasia who underwent rTMS treatment from December 2019 to December 2022 were analyzed. Patients were categorized into 2 groups based on the frequency of rTMS received: low frequency (≤1 Hz, n = 101) and high frequency (≥5 Hz, n = 93). National Institutes of Health Stroke Scale scores were recorded to quantify overall neurological deficits at baseline. Language outcomes were assessed using the Western Aphasia Battery-Aphasia Quotient (WAB-AQ) and the Boston Naming Test (BNT) at baseline, immediately post-treatment, and 2 months later. Adverse events were also recorded. One day post-treatment, the low-frequency rTMS group showed significantly greater improvements in WAB-AQ scores compared to the high-frequency group (P < .001), with significant enhancements in spontaneous speech, auditory comprehension, repetition, and naming (all P < .001). BNT scores also improved significantly in the low-frequency group (P = .025). At the 2-month follow-up, both groups exhibited continued improvement, but the low-frequency group maintained significantly greater gains in WAB-AQ (P < .001), BNT (P = .032), spontaneous speech (P < .001), auditory comprehension (P = .003), repetition (P = .041), and naming (P = .019). Linear mixed model analysis confirmed that low-frequency rTMS facilitated superior language recovery, with significant Time*Group interactions observed for WAB-AQ (P < .001), spontaneous speech (P < .001), auditory comprehension (P < .001), and naming (P = .034). High-frequency rTMS was associated with a higher frequency of headaches (P = .018) and scalp dysesthesia (P < .001). Serious adverse events were significantly less frequent in the low-frequency group (P < .001). Low-frequency rTMS is more effective and safer than high-frequency rTMS in improving language recovery for patients with post-stroke aphasia. These findings suggest a potential preference for low-frequency rTMS in clinical settings.