Support for a spouse with psychological distress can be expressed in many different ways. Previous research indicates that support expression is shaped by gender, but we do not know much about how support within marriage is provided in response to a spouse’s distress outside of a different-sex couple context. In this study, we analyze dyadic data from 378 midlife married couples (35–65 years; N = 756 individuals) within the U.S. to examine how men and women in same- and different-sex relationships provide support when they perceive that their spouse is experiencing distress. We find women in different-sex couples are less likely to report taking care of their distressed spouse’s tasks or giving their distressed spouse more personal time and space compared to women in same-sex couples and men. We also find that men in different-sex couples are less likely to report encouraging their spouse to talk compared to men in same-sex couples and women. Being personally stressed by a spouse’s distress is positively associated with providing support to that spouse, whereas feeling that a spouse’s distress is stressful for the marriage is negatively associated with providing support. This study advances understanding of gendered provisions of support in response to psychological distress in marriage, moving beyond a framing of women as fundamentally more supportive than men to a consideration of how these dynamics may be different or similar in same- and different-sex marital contexts.