<p>China’s rapidly aging population and evolving socio-economic landscape, particularly shifting gender roles, are reshaping traditional caregiving dynamics. However, limited research has examined the associations between caregiver gender and the functional and psychological health of older parents, particularly in the context of gender matching between caregivers and care recipients. This study addresses this gap by utilizing four waves of CLHLS data, employing a Logit model for estimation, and conducting robustness checks using the PSM method. The empirical results suggest that parents with sons as caregivers exhibit better functional health but poorer psychological well-being. Additionally, when the caregiver and care recipient share the same gender, the care recipient exhibits significantly better psychological health. Further analysis shows that the positive association between sons’ caregiving and functional health is statistically significant only in low-income families. while the psychological benefits of daughters’ caregiving are only evident in high-income families. Moreover, caregiving patterns show greater variation in urban areas compared to rural areas. This study contributes theoretically by developing an analytical framework that integrates gender role theory, social exchange theory, and the homophily hypothesis. The framework is applied to examine associations between caregiver gender and the health of older adults. From a practical perspective, the study identifies heterogeneous caregiving patterns across income groups and urban–rural contexts. These findings provide empirical insights for strengthening family caregiving and for designing more targeted aging policies.</p>