As an important ecological barrier and a crucial base for animal husbandry in China, the forage–livestock balance in the Three-River-Source Region (TRSR) directly impacts both the degradation and recovery of grassland. This study examines the forage–livestock balance in the TRSR over the past 13 years (2010–2022) by calculating both the theoretical and actual livestock carrying capacity, thereby providing a scientific basis for regional animal husbandry policies. Firstly, the Carnegie–Ames–Stanford Approach (CASA) model was improved to fit the specific characteristics of alpine grassland ecosystem in the TRSR. This enhanced model was subsequently used to calculate the net primary productivity (NPP) of the grassland, from which the regional grassland yield and theoretical livestock carrying capacity were derived. Secondly, the actual livestock carrying capacity was calculated and spatialized based on the number of regional year-end livestock. Finally, the livestock carrying pressure index was determined using both the theoretical and actual livestock carrying capacity. The results revealed several key findings: (1) The average grassland NPP in the TRSR was 145.44 gC/m2, the average grassland yield was 922.7 kg/hm2, and the average theoretical livestock carrying capacity was 0.55 SU/hm2 from 2010 to 2022. Notably, all three metrics showed an increasing trend over the past 13 years, which indicates the rise in grassland vegetation activities. (2) The average actual livestock carrying capacity over the 13-year period was 0.46 SU/hm2, showing a decreasing trend on the whole. The spatial distribution displayed a pattern of higher capacity in the east and lower in the west. (3) Throughout the 13 years, the TRSR generally maintained a forage–livestock balance, with an average livestock carrying pressure index of 0.96 (insufficient). However, the trend of livestock carrying pressure is on the rise, with serious overloading observed in the western part of Qumalai County and the northern part of Tongde County. Slight overloading was also noted in Zhiduo, Maduo, and Zeku Counties. Notably, Tanggulashan Town, Zhiduo, Qumalai, and Maduo Counties showed significant increases in livestock carrying pressure, while Zaduo County and the eastern regions experienced significant decreases. In conclusion, this study not only provides feasible technical methods for assessing and managing the forage–livestock balance in the TRSR but also contributes significantly to the sustainable development of the region’s grassland ecosystem and animal husbandry industry.