This study utilized hot and cold indices to evaluate the changes in extreme temperature events that occurred in subtropical highland climates from 1991 to 2020. The modified Mann–Kendall (MMK) test and the Theil–Sen (TS) slope estimator were used to analyze the linear trends in the time series of the extreme temperature indices. The northern highlands of Pakistan (NHP) were considered as a case study region. The results showed that the annual maximum temperature had a slightly increasing tendency (at the rate of 0.14 °C/decade), while the annual minimum temperature had a slightly decreasing tendency (at the rate of −0.02 °C/decade). However, these trends were not significant at the 5% significance level. The decadal averages of the hot indices were the highest in the second decade (2000s), while they were the lowest in the subsequent decade (2010s). In comparison, all the cold indices except the annual minimum value of the maximum temperature (TXn) showed a persistent decline in their decadal averages throughout the 2000s and 2010s. Overall, the frequency of hot days significantly increased in the NHP during the study period. This study found that the hot days and coldest days increased over the past three decades in the NHP. However, there was a decreasing trend in the cold spell duration, cold nights, and the coldest nights over the past three decades, as demonstrated by the trends of the cold spell duration index (CSDI), the temperature of cold nights (TN10p), and the annual minimum value of the minimum temperature (TNn) indices. These changes may impact the environment, human health, and agricultural operations. The findings provide useful insights into the shifting patterns of extreme temperature events in northern Pakistan and have crucial implications for the climate-change-adaptation and resilience-building initiatives being undertaken in the region. It is suggested that the continuous monitoring of extreme temperature events is necessary to comprehend their effects on the region and devise strategies for sustainable development.