To move beyond the focus on individual types of support, we examined the overall reciprocity of support between older adults and their adult children. Drawing on the theory of esteem enhancement, we hypothesized that the under benefited older adults, defined as older adults whose support provided is larger than support received in intergenerational relationships, may have better health conditions than those with a more or less balanced exchange of support. To test the hypothesis, we examined the relationship between the reciprocity of intergenerational support and self-rated health (SRH) among older adults in China. We also investigated the moderating role of gender in this relationship. Using data collected from 832 older adults in Wuhan, China, we found that compared to those with a balanced level of reciprocal support in the intergenerational relationship, older adults who were under benefited from the intergenerational support had better SRH. This finding is in line with the esteem enhancement theory. We also found that gender moderated the association between the reciprocity of intergenerational support and SRH. Specifically, older women who under benefit from the support had better SRH than older women with a balanced level of reciprocal support. In contrast, older men who under benefit from the support had worse SRH than older men with a balanced level of reciprocal support. This finding highlights the necessity of constructing social psychological frameworks that are attuned to gender variations for a more comprehensive comprehension of health and health-related behaviors among older adults in China. We looked at how older adults and their adult children give and receive support from each other, instead of just focusing on one type of support. We thought that older adults who give more support than they receive might have better health. To test this, we asked 832 older adults in China about the support they gave and received, and how they rated their health. We found that older adults who gave more support than they received had better health than those with an equal exchange of support. Women who gave more support than they received also had better health, but men who gave more support than they received had worse health. This shows that we need to pay attention to differences between men and women when thinking about older adults' health. We should also consider how older adults and their grown children support each other when we plan programs to promote health in older adults.