Sub-theme 1.1: Family and childhood memories.

Participants’ narratives revealed that family structures, gender norms, and early socialization played a significant role in shaping their psychological resilience and approaches to mental health self-care. Support, discipline, pressure, and emotional ambivalence within families and kinship structures became both protective and risk factors in their long-term well-being. Within this sub-theme, four key analytic points emerged:

Family support and upbringing: Family acceptance and emotional security were described as critical protective factors in participants’ lives. Supportive parenting particularly unconditional acceptance despite gender nonconformity helped cultivate early self-worth and resilience. In contrast, emotional distance or pressure to conform created long-term psychological challenges. One participant shared: “They [parents] saw me as a normal person. They never said anything negative” (P4). In contrast, another participant reflected, “My father did not understand me. I felt he did not love me… He wanted me to attend the police academy, but I knew I would never succeed there” (P18).

Gendered expectations and patriarchal pressure: Participants frequently described how rigid gender expectations often rooted in patriarchal family values impacted their emotional development. Fathers were described as emotionally distant and disciplinarian, while mothers tended to reinforce traditional gender roles or submit to paternal authority, as exemplified by this participant: “I lacked warmth from both father and mother… Father was very masculine… Father never hugged me.” (P18). These expectations discouraged emotional expression and contributed to feelings of alienation or internal conflict.

Sibling dynamics and kinship roles: In large Thai families, sibling relationships and extended kinship networks acted as both stressors and sources of resilience. Participants reported being compared to siblings, forced into gender-conforming behaviors, or subjected to ridicule. One participant shared: “My older brother liked to force me to play football and dress like a boy. But I liked wearing skirts and wanted to be a girl since kindergarten.” (P17). However, in some cases, kin or siblings also offered protection or a sense of belonging. One participant recalled, “My relatives were friendly and even happy about who I am” (P1). These ambivalent dynamics deeply shaped participants’ sense of self and mental health practices.

Burden of responsibility: Participants frequently described a lifelong expectation to shoulder responsibility for their families, a burden that shaped their emotional experiences and life trajectories. Rather than receiving care, many felt compelled to provide it, financially, emotionally, or through fulfilling familial duties such as securing housing, caring for aging parents, or maintaining family honor. These expectations often functioned as both pressure and motivation, driving participants to work hard, delay personal aspirations, or suppress aspects of their identity to meet family obligations.

One participant reflected, “I only thought about how to make my family’s life better… I wanted to quickly buy a house for my parents… Now, the person I loved most, I wanted them to be happy, but they are no longer with me.” (P14).

Sub-theme 1.2: Community environment.

Participants’ life stories reflected the influence of broader Thai socio-cultural and structural contexts on identity formation and mental health self-care. From early schooling to livelihood strategies and everyday interactions with neighbors, participants navigated a world where gender norms, class mobility, and communal expectations shaped their psychological resilience and coping strategies. These experiences illustrate how place, education, and community belonging are not merely background conditions but active components of LGBTQ+ individuals’ mental health trajectories.

Schooling: For many participants, schools were the first social institutions where they became acutely aware of gender expectations and the boundaries of socially acceptable behavior. In Thailand, where gendered school uniforms and moral discipline are institutionalized, schools were both spaces of early trauma and sites of resistance. Participants recounted how enforcement of gender norms through punishment or ridicule deeply affected their sense of self and emotional well-being. One participant described that “The teacher said it [dressing differently from my assigned sex at birth] wasn’t allowed. They called me in for punishment, squeezed my arm, and shook me… I had to dress properly. They said I couldn’t be like this.” (P17).

Socioeconomic mobility and livelihood trajectories: Education and employment were interconnected pathways through which participants sought stability, dignity, and recognition. Education provided opportunities for social mobility, particularly for those who viewed academic achievement as a means to uplift their families. As one participant shared, “I grew up poor in Rayong and all I could think about was how to make life better for my family. I studied hard, became the top student, and earned a scholarship to Chulalongkorn University. That moment was the greatest pride of my life” (P14).

However, translating educational success into economic security was not guaranteed. Participants’ work experiences revealed both empowerment and vulnerability. For some, employment became a source of purpose and resilience, “All I thought about was how to make life better for my family… I worked hard because I wanted to buy a house for my parents” (P14). For others, discrimination undermined their ability to remain employed, such as one participant who recalled, “My boss bullied me by sending me to distant branches until I had to resign” (P8). These accounts highlight how socioeconomic mobility was shaped not only by personal effort but also by structural barriers tied to gender identity and social expectations.

Community relationships and belonging: Neighborhoods and local communities played a dual role in shaping participants’ emotional landscapes. In rural and peri-urban areas, tight-knit relationships provided social support but also subjected individuals to surveillance, gossip, or even boundary violations. In contrast, some found ways to establish trusting, respectful relationships with neighbors, building informal safety nets essential for aging well. These mixed experiences highlight the significance of localized social networks in Thai society. One participant shared, “I cooked and shared food with my neighbors… We trusted each other so much that they even kept a spare key to my house.” (P13).

Sub-theme 1.3: Cultural beliefs and mental health.

Cultural and spiritual beliefs played a significant role in shaping the mental health experiences of LGBTQ+ individuals in Thailand, particularly in later life. While religion and cultural practices offered grounding, routine, and meaning in times of personal hardship, they also reinforced silence, guilt, and conformity. Several participants navigated these contradictions by reframing their relationship to tradition embracing certain values like mindfulness or filial piety while rejecting gender-essentialist or heteronormative interpretations. In this way, participants demonstrated cultural negotiation: not full assimilation nor total rejection, but an ongoing reshaping of beliefs to support self-acceptance and mental wellness.

Evolving gender perceptions across generations: Thailand’s cultural history reflects both tolerance and limitation in relation to gender diversity. In earlier generations, rigid binary gender roles, reinforced through family, education, and media, often silenced LGBTQ+ identities, labeling them as “deviant” or “inappropriate.” However, recent decades have seen greater social visibility, especially with more LGBTQ+ representation in media, shifts in public opinion, and legal discourse.

Participants reflected on this transformation, recognizing both the pain of growing up under rigid norms and the relief they feel seeing younger LGBTQ+ people embraced more openly. The shift is bittersweet: a mixture of pride, hope, and unresolved grief for what was once denied. One participant reflected, “Right now, these LGBT kids are lucky, you know, that they are more accepted in society than we ever were” (P4). Another echoed this sentiment by noting that acceptance had expanded beyond public discourse and into personal relationships: “As society becomes more accepting, the people around me also accept me more” (P29).

Religious beliefs and spiritual practices: Buddhism is a central component of Thai life and moral discourse. For LGBTQ+ participants, Buddhist teachings, particularly those emphasizing impermanence, compassion, and detachment, provided frameworks for resilience and self-reflection. Some participants found comfort through merit-making, meditation, and temple visits, especially when dealing with loss or trauma. Religious rituals were also used to honor parents, fulfill spiritual obligations, or regain emotional balance. However, the interplay between Buddhist morality and LGBTQ+ identities was complex. While Buddhist doctrine does not explicitly condemn homosexuality, certain interpretations (especially around precepts like the Third Sila regarding sexual misconduct) have historically been used to shame or marginalize non-heteronormative identities. Participants responded by selectively adopting teachings that supported peace of mind while rejecting others that caused guilt or self-blame. One participant shared, “I went to the temple for peace of mind. I like the silence, and I feel that at a certain age, one should begin going to the temple.” (P4).

Leisure and well-being practices: Beyond formal religion, participants emphasized the importance of daily rituals and leisure activities in promoting mental health. These ranged from spiritual practices like barefoot walking and grounding, to hobbies such as gardening, cooking, and travel. Such practices were often framed not only as enjoyable but essential, allowing for physical health, emotional release, and mental clarity. Participants described how maintaining balance, a core Thai value, guided their self-care. Aging was seen as a time to slow down, enjoy simplicity, and focus inward. For many, these practices helped manage the long-term effects of trauma, stress, and social exclusion without reliance on formal psychological services. One participant explained, “Grounding helps balance my body, I walk barefoot on the grass, it keeps me healthy and costs nothing.” (P21).

Painful memories and traumatic relationships: While cultural beliefs offered tools for resilience, they also contributed to environments that allowed psychological wounds to go unaddressed. Participants shared stories of painful relationships, sexual violence, and betrayal, many of which were compounded by shame, silence, and lack of support. Several recalled traumatic experiences involving teachers, monks, or family members, with no clear path to justice or healing due to societal taboos and institutional barriers. In some cases, religion was used to cope or rationalize these events. In others, it deepened feelings of sin or unworthiness. Despite this, many participants worked through these experiences by finding personal meaning, accepting emotional scars, and rebuilding life on their own terms. One participant shared, “I was raped by a monk… I had to endure it while staying in the temple for three years.” (P17).

Sub-theme 1.4: Intimacy and romantic experience.

For older LGBTQ+ Thais, intimacy was deeply intertwined with their sense of identity, social belonging, and emotional survival. Across their lifespans, romantic and sexual experiences provided spaces for both empowerment and vulnerability. While many participants encountered rejection, heartbreak, or trauma, others recalled warmth, affirmation, and long-term emotional bonds even outside conventional notions of romantic relationships. Some redefined partnerships beyond labels; others embraced singleness as a conscious and liberating choice. Together, these narratives reveal how love was reimagined as care, understanding, and dignity, not just romance or sexual connection.

Fluid relationships, emotional labor, and autonomy: Participants’ romantic and sexual experiences evolved across the life course, reflecting shifting meanings of love, intimacy, and self-worth. Early relationships were often sources of exploration, affirmation, and emotional intensity, yet also spaces of heartbreak, violence, or betrayal in a society that stigmatized LGBTQ+ identities. These formative experiences shaped lifelong emotional patterns and coping strategies. As participants aged, many redefined commitments on their own terms, prioritizing peace, self-respect, and mental health over societal expectations of partnership or marriage. For some, chosen families, caregiving bonds, or long-term companionship provided a profound sense of belonging without romantic labels.

One participant explained, “Being with a woman hurt more… it was both friend and lover in one, far deeper than teenage puppy love” (P30). Another reflected on non-romantic commitment as a form of emotional fulfillment: “I’ve taken care of my boss for 30 years… we don’t need to be lovers. This care itself makes life complete” (P12).

Sub-theme 2.1: Coping with stigma and discrimination.

For older LGBTQ+ adults in Thailand, experiences of stigma and discrimination were long-lasting yet transformative. Many had endured ridicule, exclusion, and misunderstanding across different life stages, from childhood classrooms and temples to modern workplaces. Their coping strategies reflected both personal resilience and cultural adaptation, often grounded in Buddhist values of emotional balance, self-control, and compassion. Through such strategies, participants learned to coexist within a heteronormative and hierarchical society that often privileges conformity.

Facing bullying and emotional regulation: Many participants traced their early struggles with stigma back to childhood bullying or mockery from peers and teachers, which shaped their lifelong sense of self-worth. While some internalized shame, others learned to defend themselves and later reframed those experiences as lessons in strength and endurance. Over time, emotional maturity and Buddhist mindfulness enabled them to manage anger and sadness constructively. As one participant explained, “When we recognize and understand the anger that arises, we can return to our mind more quickly and realize that these things are natural truths: they arise, exist, and eventually fade.” (P28).

This capacity for emotional regulation reflected a deeply Thai way of coping, cultivating consideration, maintaining calm, and transforming pain into understanding. Participants’ ability to interpret suffering through Buddhist teachings helped them reclaim dignity and reduce the internalized effects of discrimination.

Selective avoidance and conflict navigation: Avoidance, modulation of self-expression, and strategic withdrawal emerged as key emotional survival strategies among participants. In a cultural context where direct confrontation is discouraged, LGBTQ+ elders did not perceive avoidance as passivity but as a deliberate form of boundary-setting, emotional intelligence, and self-preservation. Participants described choosing silence, minimizing visibility, or adjusting their tone, clothing, and behavior to navigate family gatherings, workplaces, and religious spaces. These practices allowed them to maintain social harmony while protecting their psychological well-being in environments where gender diversity remained stigmatized.

As one participant shared, “I walk away and avoid confrontation. Most of the time it’s just teasing. Don’t use emotions… If something lingers, I’ll clear it up later” (P22). Another described calibrating visibility as a form of self-protection: “I will not stand out too much, but I also will not lag behind” (P12).

Cultural routines and spiritual coping: Daily and religious routines served as powerful emotional anchors. Participants described engaging in merit-making, temple visits, and Buddhist rituals to connect with lost loved ones and maintain inner peace. These practices reveal how spirituality becomes both a coping mechanism and a cultural affirmation. For many, participating in temple life and rituals reinforced their social belonging as “good people”, countering societal perceptions of LGBTQ+ identities as morally deviant. One participant shared, “My mother passed away in 2021, so I choose to give alms every Monday, the day she died… it feels like she goes along with me.” (P5).

Sub-theme 2.2: Barriers to mental health services.

In Thailand, entrenched myths and sexual prejudice shaped access to mental health care, with many participants reporting they had never sought professional services, relying instead on the internet. Those who did seek care often described negative experiences, such as receiving advice that felt dismissive or irrelevant, which further reinforced distrust and spread misconceptions about mental health services.

Stigma, rumors, and misunderstanding: Stories circulated within communities that seeing a psychiatrist meant being mentally unstable. Participants expressed hesitation to seek help because they feared being judged or labeled, and some noted that transgender identities had historically appeared alongside terms related to mental illness in official documents. Such perceptions shaped how participants understood mental health care and their willingness to access it. One participant shared, “They think going to see a psychiatrist means you’re insane… I’m still not brave enough to consult.” (P1).

Negative encounters: For those who sought help, some participants reported distressing interactions that undermined their trust in mental health professionals. Accounts included unethical behaviors, discriminatory remarks, and experiences that left them feeling unsafe and reluctant to return for care. One participant recalled, “I was sexually harassed by a psychiatrist… I am afraid every time I see a doctor now” (P18). Such encounters reinforced hesitation to seek formal support and deepened psychological vulnerability.

Others, however, described more positive interactions, where empathetic practitioners created a sense of safety and relief. As one participant noted, “If I can talk with someone I trust, half of the problem is gone” (P24).

Economic constraints: Economic limitations shaped participants’ decisions about whether to seek mental health support. Many perceived therapy as costly and unaffordable, making it an option reserved for those with greater financial resources. Even with partial reimbursement, expenses remained burdensome and discouraged continued care. As one participant shared, “I paid over 8,000 baht, and got 4,000 back from social security… the nurses even sat and talked with me.” (P13).

Sub-theme 2.3: Cultivating joy, pride, and self-reliance.

Daily rituals, creative pursuits, and queer pride narratives fueled psychological resilience, with many participants finding happiness and pride in living self-reliantly. Building confidence and self-worth through independence, community gathering, and social contribution allowed them to strengthen their identities. By joining group activities and engaging in community initiatives, they developed a sense of belonging and cultivated lasting joy and psychological well-being.

Joy through simplicity and giving: Happiness was defined not by material success but by freedom, simplicity, and generosity. Participants linked joy to independence and the act of giving reflects values deeply embedded in Thai culture. As one participant noted, “I only do what I can without making myself uncomfortable. I don’t care how much others donate; I only care about how much peace I feel. I am happy simply with my own way of giving.” (P28).

Positive thinking and emotional resilience: Optimism became both a survival mechanism and a moral stance. Participants consciously trained themselves to reinterpret adversity through positive thinking and humor. This perspective illustrates how psychological resilience is intertwined with Buddhist notions of impermanence and acceptance, finding peace through inner control rather than external validation. As one participant shared, “I am not a stressed person; I am positive. Many people tell me I think positively, and I believe it too.” (P21).

Pride and self-reliance as dignity: Pride for participants was not arrogance but moral fulfillment from education, work, and contribution. One participant shared, “I feel proud to have reached the highest level of education, earning a doctorate and using my knowledge to help others.” (P27).

Such pride affirms LGBTQ+ elders’ social worth in a context where respect is often tied to productivity and filial duty. Self-reliance, likewise, reflected the dignity of not being a burden. As one participant shared, “We must control ourselves… we cannot always rely on others. We must be strong, not weak-hearted.” (P17).

Immunity and inner protection: Repeated experiences of betrayal and loss led to the development of psychological “immunity,” a protective shield balancing caution and self-compassion. This form of inner immunity parallels the Buddhist teaching of equanimity amid suffering showing how maturity transforms emotional scars into wisdom.

“Now, if anyone invites me to invest, I block them right away… I’ve been deceived before and ruined. I won’t believe easily again.” (P8)

Sub-theme 2.4: Community contribution and advocacy.

Volunteering and organizing were described as healing practices that fostered resilience, dignity, and belonging. By contributing to others, participants strengthened self-worth, affirmed queer pride, and transformed personal struggles into shared empowerment. Acts of helping others reflected deeply rooted Thai values of kind-hearted giving and reciprocal gratitude, while community engagement redefined what it means to live well and grow old as LGBTQ+ in Thailand.

Communal care and social contribution: LGBTQ+ networks provided crucial emotional support, belonging, and identity affirmation. These spaces, including public gatherings and queer cultural events, allowed participants to feel accepted without explanation. As one participant noted, “We never ask each other, ‘What are you? What am I?’… We just are the way we are” (P5), illustrating how community ties normalized diversity and eased social pressures.

Care within these networks often became practical and life-sustaining. Participants described offering refuge and emotional support to peers rejected by their families. One recalled helping a friend who was struggling with addiction and AIDS, saying simply, “I told him to come stay with me” (P18), highlighting how chosen families served as safety nets.

Beyond personal networks, many engaged in acts of public service that blended social contribution with self-worth. Some used personal skills to support others, for instance, one participant “used [his] hair-cutting skills as free community service” (P28), while another shared that they “…organized a charity concert to raise funds for the gynecological cancer institute” (P9). These efforts transformed care into a meaningful practice that reinforced dignity, purpose, and connection.

Digital and everyday advocacy: Digital spaces such as Facebook and TikTok offered new avenues for connection, expression, and activism. While some participants found online communication emotionally distant, others embraced it as a supportive platform for mental well-being, education, and empowerment. Personal storytelling and online volunteering allowed them to reach wider audiences, especially in a culture where open confrontation is often discouraged. One participant noted, “…online communities bring people together and support mental well-being.” (P3).

At the same time, participants practiced what might be called “quiet advocacy” in everyday life, living authentically, mentoring youth, and speaking calmly about gender diversity. One participant shared, “Today, society is more open and accepting… many are so talented, sometimes more than straight men and women, which makes the world recognize them.” (P29).

Through such subtle, relationship-based change, LGBTQ+ elders contributed to a gradual cultural shift toward inclusion and respect.

Sub-theme 2.5: Physical health as mental anchor.

Attention to exercise, nutrition, and chronic illness management supported emotional stability. Older LGBTQ+ adults described health care as a holistic practice combining physical activity, creative engagement, balanced routines, and mental well-being to cope with life pressures and sustain resilience.

Holistic self-care and emotional balance: Participants engaged in physical activity, walking, swimming, dancing, or gym workouts, not merely for fitness but for emotional renewal. Exercise and mindfulness served as parallel routes to regulating stress and restoring joy. Many viewed their daily health routines as sacred acts that linked self-discipline with compassion. Such practices reveal a holistic concept of wellness, where physical vitality, spiritual composure, and emotional clarity reinforce each other. One participant shared, “If our health is good… everything we have becomes more valuable. Health must come first.” (P12).

Connection and caregiving as emotional grounding: Caring for others, elders, relatives, friends, or community members, was described as both a responsibility and a source of happiness. These caregiving roles reflected the Thai cultural expectation of reciprocal care while giving LGBTQ+ elders a renewed sense of social belonging. Such acts of love and service transformed conventional images of dependency in old age into empowerment through nurturing others. As one participant explained, “My pride is being the one who stays with my mother, caring for her and my aunt, becoming the center of the family.” (P28).

Sub-theme 2.6: Self-education on mental health.

Continuous learning was central to participants’ mental self-care. Many turned to digital media, peers, and life reflection to expand mental-health literacy, combining Buddhist insights with modern psychological ideas. Knowledge was viewed not merely as information but as moral cultivation.

Digital and experiential learning: Participants frequently relied on YouTube, Facebook, and Google to learn about emotional regulation, mindfulness, and LGBTQ+ rights. They also drew upon peers’ life stories and community discussions as informal educational resources. One participant described how online guidance directly informed self-care practices, stating, “I listened to Dr. Prawase on YouTube. He said to take care of myself… so I started doing that, and gradually it got better” (P3). Another participant explained that they not only consumed information but also shared it with others, particularly health-related resources, noting, “I sent links and show friends how to use Google to search for information” (P22). This blend of digital access and peer-based learning demonstrates how Thai LGBTQ+ elders creatively integrate new knowledge into traditional ways of knowing.

Applying and sharing knowledge for growth: Participants applied insights from self-learning to everyday life, practicing mindfulness, setting boundaries, and accepting themselves with compassion. Many extended this learning to others, teaching meditation, giving online talks, or mentoring peers through personal experience.

One participant explained, “Bad experiences can harm your mental health, but if you adapt quickly, they can also give you the strength to carry on.” (P30). And another shared,

“I once attempted suicide… but now I can return to society and serve as a role model for others with mental health struggles.” (P19).

Sharing became both altruism and affirmation, a way to turn pain into wisdom and reinforce the belief that resilience is learnable and collective.