Introduction <p>Despite facing challenges that are distinct from their cisgender and heterosexual counterparts, few studies have engaged the voices and experiences of older-adult gay men and transgender women in Thailand.</p> Methods <p>In-depth, semi-structured online interviews were conducted in Thai/Northern dialect to explore the lived experiences and perspectives of older-adult gay men (<i>n</i> = 9) and transgender women (<i>n</i> = 9) in rural, semi-urban, and urban settings in Chiang Mai province. Transcripts were reviewed using reflexive thematic analysis, with feminist care theory as a sensitizing framework.</p> Results <p>Economic and health/mental health disparities accrued over lifetime experiences of marginalization engender specific care needs and resilience among older-adult gay men and transgender women. Reliance on kinship networks, Thailand’s traditional source of elder care, was often precluded due to tenuous family relationships due to ongoing stigma and discrimination. Resilience expressed through attention to physical well-being, a spiritual outlook, financial planning, and community involvement suggest pathways to enhance healthy aging and care.</p> Conclusions <p>Incongruence between lived experiences of older-adult gay men and transgender women, and normative discourses of aging and care in Thailand, illustrate the inability of the present social welfare and healthcare systems to meet their needs, warranting focal inclusion of older LGBT+ adults in policymaking, research, and advocacy.</p> Policy Implications <p>Resource allocation, capacity-building, and training enabling local LGBT + and other community-based organizations to contribute competent care, support for informal LGBT+ older adult networks, and disaggregated national data on LGBT+ adults, may support culturally-relevant and evidence-based local care strategies for older LGBT+ adults that build on Thailand’s collectivist orientation and Buddhist cultural strengths.</p>