•Coping behaviors by aging LGBTQ adults influence healthcare utilization•Social support remains a protective factor for aging LGBTQ adults utilizing healthcare•Significant differences exist among aging LGBTQ adults utilizing healthcare•Aging LGBTQ adults may delay seeking treatment because of provider discrimination This systematic review was conducted to identify, synthesize, and elucidate the coping mechanisms described by aging lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults (60+) when utilizing healthcare. A comprehensive literature search was conducted in Embase and Ovid databases to identify studies of aging LGBTQ adults using coping mechanisms during healthcare utilization. Qualitative and quantitative studies published in English between 1969 and 2020 were included and assessed with COREQ, STROBE Statement, and CASP instruments. Of 227 articles identified, six were included in the review. The final synthesis revealed that coping mechanisms were associated with social support, social network size, provider competency, and disclosure management. Frequency of appointments varied when seeking healthcare, and one study indicated delay in treatment. This systematic review highlights various coping mechanisms associated with healthcare utilization and supports the need to develop research uniquely focused on aging LGBTQ adults.