The elevation history of the Himalaya-Tibet orogen is central to understanding the evolution and dynamics of both the Indian-Asia collision and the Asian monsoons. The surface elevation history of the region is largely deduced from stable isotope (δ 18 O, δD) paleoaltimetry. This method is based on the observed relationship between the isotopic composition of meteoric waters (δ 18 O p , δD p ) and surface elevation, and the assumption that precipitation undergoes Rayleigh distillation under forced ascent. Here we evaluate how elevation-induced climate change influences the δ 18 O p -elevation relationship and whether Rayleigh distillation is the dominant process affecting δ 18 O p . We use an isotope-enabled climate model, ECHAM-wiso, to show that the Rayleigh distillation process is only dominant in the monsoonal regions of the Himalayas when the mountains are high. When the orogen is lowered, local surface recycling and convective processes become important as forced ascent is weakened due to weaker Asian monsoons. As a result, the δ 18 O p lapse rate in the Himalayas increases from around −3 ‰/km to above −0.1 ‰/km, having little relationship with elevation. On the Tibetan Plateau, the meridional gradient of δ 18 O decreases from ~ 1 ‰/° to ~ 0.3 ‰/° with reduced elevation, primarily due to enhanced sub-cloud re-evaporation under lower relative humidity. Overall, we report that using δ 18 O p or δD p to deduce surface elevation change in the Himalaya-Tibet region has severe limitations and demonstrate that the processes that control δ 18 O p vary by region and with surface elevation. In sum, we determine that the application of δ 18 O-paleoaltimetry is only appropriate for 7 of the 50 sites from which δ 18 O records have been used to infer past elevations.