In 2008 Przewalski's gazelle Procapra przewalskii, endemic to the Qinghai–Tibetan Plateau, China, was recategorized from Critically Endangered to Endangered on the IUCN Red List. The species is still, however, threatened, and the human population and accompanying domestic livestock are increasing around Qinghai Lake. Here we provide up-to-date information on the distribution and population size of the species, evaluate its current conservation status and discuss the difficulties of protecting this gazelle species. We used both distance sampling and total counts to survey 16 sites where the species has been reported and found it at 13 of these, occupying a total area of c. 250 km2. Population size estimated from distance sampling (1,635) and total counts (1,544) was similar. About 20% of the gazelles located were in newly discovered areas for the species. The results indicate an overall growth in the population of Przewalski's gazelle since 2003, although some subpopulations have declined or been extirpated. In spite of conservation efforts Przewalski's gazelle is still threatened by habitat degradation and loss, habitat fragmentation, fencing, intensified competition with domestic livestock and predation. Further growth of this gazelle population is constrained by limited habitat availability and human–gazelle conflict. We recommend that management and conservation strategies need to incorporate comprehensive knowledge of the gazelle, long-term monitoring, and captive breeding of injured and orphaned gazelles to form a potential pool of individuals for future reintroductions to the historical range of the species outside the Qinghai Lake basin.