Livelihoods in Trans-Himalaya, particularly in Ladakh, generally depend on ecosystem-based natural resources. The present chapter explores the nature-based livelihood strategies in Ladakh, a high-altitude region in the Indian Himalayas. It examines how the communities in this challenging environment use their natural resources, traditional knowledge, and innovative approaches to sustain livelihoods historically. However, in the past few decades, the livelihoods of the communities have been affected due to the changing climate and development activities, especially tourism. The chapter documents and analyses the data related to promoting nature-based livelihood strategies adopted in the past two decades. Further, the chapter discusses the effectiveness of these strategies in the face of climate change and socio-economic challenges by implementing region-specific nature-based solutions, and how these nature-based solutions provide an alternative livelihood. Further, it is elaborated that these solutions can be replicated in other Trans Himalayan regions, subsequently; recommendations are provided for achieving different sustainable development goals in similar mountainous regions.