Forests of northeastern North America have been exposed to anthropogenic acidic inputs for decades, resulting in altered cation relations and disruptions to associated physiological processes in multiple tree species, including sugar maple (Acer saccharum Marsh.). In the current study, the impacts of calcium (Ca) and aluminum (Al) additions on mature sugar maple physiology were evaluated at the Hubbard Brook Experimental Forest (Thornton, NH, USA) to assess remediation (Ca addition) or exacerbation (Al addition) of current acidified conditions. Fine root cation concentrations and membrane integrity, carbon (C) allocation, foliar cation concentrations and antioxidant activity, foliar response to a spring freezing event and reproductive ability (flowering, seed quantity, filled seed and seed germination) were evaluated for dominant sugar maple trees in a replicated plot study. Root damage and foliar antioxidant activity were highest in Al-treated trees, while growth-associated C, foliar re-flush following a spring frost and reproductive ability were highest in Ca-treated trees. In general, we found that trees on Ca-treated plots preferentially used C resources for growth and reproductive processes, whereas Al-treated trees devoted C to defense-based processes. Similarities between Al-treated and control trees were observed for foliar cation concentrations, C partitioning and seed production, suggesting that sugar maples growing in native forests may be more stressed than previously perceived. Our experiment suggests that disruption of the balance of Ca and Al in sugar maples by acid deposition continues to be an important driver of tree health.