The Tibetan Plateau, the world's largest critical ecological hotspot, teems with valuable ecosystem services. Yet, its expansive alpine ecosystems face growing anthropogenic pressures, particularly intensified land use. This study delves into ecosystem service supply-demand ratio, land use patterns, and their spatiotemporal evolution on the Tibetan Plateau from 1980 to 2020. We employed ecosystem service supply-demand ratios and trade-off models to reveal trends in three key ecosystem services: soil conservation, carbon sequestration, and water provisioning. We also examined the impact of land use development on these ratios. The land use landscape remained relatively stable during 1980-2020, dominated by alpine grasslands and deserts. Soil conservation services showed an increasing supplydemand ratio, while carbon sequestration and water provisioning initially rose, then declined. These ratios displayed a spatial pattern, increasing from northwest to southeast, mirroring land use transitions. We found distinct spatial disparities in the correlation between land use intensity and ecosystem service supply-demand ratio, concentrated in the west-central, southern, and east-central Tibetan Plateau. This research is pivotal for shaping land use policies and patterns in the unique Tibetan Plateau alpine ecosystem.