Absolute pitch (AP) has been shown to be associated with morphological changes and neurophysiological adaptations in the planum temporale, a cortical area involved in higher-order auditory and speech perception processes. The direct link between speech processing and AP has hitherto not been addressed. We provide first evidence that AP compared with relative pitch (RP) ability is associated with significantly different hemodynamic responses to complex speech sounds. By systematically varying the lexical and/or prosodic information of speech stimuli, we demonstrated consistent activation differences in AP musicians compared with RP musicians and nonmusicians. These differences relate to stronger activations in the posterior part of the middle temporal gyrus and weaker activations in the anterior mid-part of the superior temporal gyrus. Furthermore, this pattern is considerably modulated by the auditory acuity of AP. Our results suggest that the neural underpinnings of pitch processing expertise exercise a strong influence on propositional speech perception (sentence meaning).