Purpose: To investigate the effects of acute caffeine (CAFF) intake on physical performance in elite women handball players. Methods: A total of 15 elite women handball players participated in a randomized, double-blind study. In 2 different trials, participants ingested either a placebo (cellulose) or 3 mg of CAFF per kilogram of body mass (mg/kg bm) before undergoing a battery of neuromuscular tests consisting of handball throws, an isometric handgrip strength test, a countermovement jump, a 30-m sprint test (SV) and a modified version of the agility T test. Then, participants performed a simulated handball game (2 × 20 min), and movement patterns were recorded with a local positioning system. Results: Compared with the placebo, CAFF increased ball velocity in all ball throws (P = .021–.044; effect size [ES] = 0.39–0.49), strength in isometric handgrip strength test (350.8 [41.2] vs 361.6 [46.1] N, P = .034; ES = 0.35), and countermovement-jump height (28.5 [5.5] vs 29.8 [5.5] cm; P = .006; ES = 0.22). In addition, CAFF decreased running time in the SV (4.9 [0.2] vs 4.8 [0.3] s; P = .042; ES = −0.34). In the simulated game, CAFF increased the frequency of accelerations (18.1 [1.2] vs 18.8 [1.0] number/min; P = .044; ES = 0.54), decelerations (18.0 [1.2] vs 18.7 [1.0] number/min; P = .032; ES = 0.56), and body impacts (20 [8] vs 22 [10] impacts/min; P = .032; ES = 0.30). However, postexercise surveys about self-reported feelings of performance indicate that players did not feel increased performance with CAFF. Conclusion: Preexercise ingestion of 3 mg/kg bm of CAFF improved ball-throwing velocity, jump, and sprint performance and the frequency of in-game accelerations and decelerations in elite women handball players.