Understanding the transition from meteorological to hydrological drought is essential for accurately predicting hydrological droughts. However, the factors driving this transition are intricate, and a comprehensive understanding of how direct human activities influence this shift in drought is lacking. In this study, we initially explored the spatiotemporal correlation between the occurrence of meteorological and hydrological droughts. Subsequently, we formulated multiple hydrological replenishment scenarios using the soil and water assessment tool (SWAT) model to assess the environmental impact of the transition from meteorological to hydrological droughts. The Xijiang River Basin (XRB), the primary tributary of the Pearl River basin, was selected as the study area. Our results identified 91 meteorological droughts in the XRB, and only 66 hydrological droughts from 1978 to 2018. The transition rate from meteorological to hydrological drought demonstrated large spatial variability, with a basin-average rate of 56% and the lowest transition rate of 45% in the headstream The transition from meteorological to hydrological drought was mostly rapid between November and December (~2 months), but can be prolonged during spring (about 3–5 months) and winter (around 7–9 months). Additionally, analysis of regeneration scenarios indicated that human activity has mitigated drought severity over recent decades. The primary driver affecting drought duration and frequency during the transition from meteorological to hydrological droughts shows conspicuous spatial disparities in densely populated areas. Although human activity significantly contributes to drought duration and severity compared to climate change during the transition in the headstream, its effects are more pronounced downstream in terms of drought duration and frequency. One plausible explanation is that increased water consumption downstream has considerably prolonged drought progression, whereas water management has counteractive effects on drought progression due to climate change in the headstream. Our findings offer valuable insights into the transition process from meteorological to hydrological droughts in the presence of extensive human activities.