Quantifying the attribution of climate change and human activities on runoff and suspended sediment load is crucial for formulating future watershed management measures, especially in the ecologically fragile alpine region, which is more susceptible to climate change and human activities. In this study, the temporal changes in runoff-suspended sediment load and the potential impact factors (i.e., precipitation, potential evapotranspiration (PET), land use/land cover change (LULC) and reservoir operation) were investigated in the Lhasa River Basin (LRB) from 1956 to 2020. In addition, the contributions of those factors to the changes in runoff and suspended sediment load were quantitatively evaluated based on physically-based Soil and Water Assessment Tools (SWAT). The results indicated that annual runoff and suspended sediment load showed an increasing but insignificant trend during 1956-2020, while annual precipitation and PET showed a significant increasing trend at a rate of 0.94 and 1.07 mm/yr, respectively. LULC mainly presented an increase in forestland area followed by a decrease in grassland and bare land area due to the implementation of ecological projects. Runoff and suspended sediment load changed abruptly at approximately 1995 and 2005 based on three abrupt change identification methods, thus, the study period was further divided into three substages: baseline period (P0, 1956-1994), dramatically increased period (P1, 1995-2004) and slightly decreased period (P2, 2005-2020). The attribution analysis showed that climate change was the dominant contributor to runoff and suspended sediment load increments during P1. LULC caused the decline in runoff and suspended sediment load in both P1 and P2, with their contribution increasing significantly from 0.40% and 4.73% in P1 to 50.24% and 51.79% in P2, respectively. Reservoir operation was the second key factor in runoff and suspended sediment load reduction in P2, contributing 42.07% and 43.72%, respectively. These findings provide the scientific foundation for reasonably allocating water resources and statistical support for the benefit evaluation of implementing ecological projects in the basin. Impacts of climate change and human activities on runoff-suspended sediment load change were quantified, with climate change dominated runoff and suspended sediment load increasing during 1995-2004. LULC is mainly an increase in forestland area, and reservoir operation caused runoff and suspended sediment load reductions during 2005-2020. image