Glacier health across High Mountain Asia (HMA) is highly heterogeneous and strongly governed by regional climate, which is variably influenced by monsoon dynamics and the westerlies. We explore four decades of glacier energy and mass balance at three climatically distinct sites across HMA by utilising a detailed land surface model driven by bias-corrected Weather Research and Forecasting meteorological forcing. All three glaciers have experienced long-term mass losses (ranging from −0.04 ± 0.09 to −0.59 ± 0.20 m w.e. a−1) consistent with widespread warming across the region. However, complex and contrasting responses of glacier energy and mass balance to the patterns of the Indian Summer Monsoon were evident, largely driven by the role snowfall timing, amount and phase. A later monsoon onset generates less total snowfall to the glacier in the southeastern Tibetan Plateau during May–June, augmenting net shortwave radiation and affecting annual mass balance (−0.5 m w.e. on average compared to early onset years). Conversely, timing of the monsoon’s arrival has limited impact for the Nepalese Himalaya which is more strongly governed by the temperature and snowfall amount during the core monsoon season. In the arid central Tibetan Plateau, a later monsoon arrival results in a 40 mm (58%) increase of May–June snowfall on average compared to early onset years, likely driven by the greater interaction of westerly storm events. Meanwhile, a late monsoon cessation at this site sees an average 200 mm (192%) increase in late summer precipitation due to monsoonal storms. A trend towards weaker intensity monsoon conditions in recent decades, combined with long-term warming patterns, has produced predominantly negative glacier mass balances for all sites (up to 1 m w.e. more mass loss in the Nepalese Himalaya compared to strong monsoon intensity years) but sub-regional variability in monsoon timing can additionally complicate this response.