What percentage of transgender went to therapy before transitioning

1. Mental‑health screening in specialty clinics: near‑universal in old clinical models

Longstanding multidisciplinary gender‑identity clinics historically required mental‑health assessment before medical steps: the VU Medical Center in Amsterdam screened all patients with mental‑health specialists and, across 1972–2015, 70% of the 6,793 people who sought care there were started on hormone therapy after that screening ^{[1] [2]}. Those figures reflect an older gatekeeping model in which psychological evaluation was a routine part of eligibility assessments at referral clinics ^{[1] [2]}.

2. Research reviews and surveys show varied experiences outside specialty centers

Population surveys and systematic reviews do not report a single, consistent pre‑transition therapy rate. Large nonprobability surveys such as the 2015 U.S. Transgender Survey are used to study detransition and care patterns but ask different questions (e.g., about detransition or receipt of specific treatments) rather than a single “went to therapy before transitioning” item, making direct percentage estimates difficult to extract from those data ^[2]. Reviews that summarize many studies emphasize improved well‑being after transition but also note that counseling and monitoring practices vary across settings ^[4].

3. Youth pathways: many seen by multidisciplinary teams but not all undergo therapy first

For young people, specialty gender clinics and guidelines (WPATH and clinic protocols) emphasize psychological and family assessment before medical interventions; an Amsterdam cohort found very low discontinuation after puberty blockers, reflecting structured clinic pathways (for example, only 1.9% of adolescents who started puberty suppressants did not later pursue hormones in one cited study) ^[5]. Advocacy groups note near‑universal clinical follow‑up in those programs, while also pointing out that access barriers mean many youth never reach specialty care for comprehensive assessment ^{[6] [5]}.

4. Access barriers and insurer denials change who is represented in clinic data

Clinic‑based percentages (people who received mental‑health screening) derive from patients who reached specialized services; they may overstate how common formal therapy is across the broader trans population because many people never access specialty clinics. Multiple reports note insurance denials and other barriers—up to 25% of people who sought hormone therapy coverage were denied in some studies—which affects who gets comprehensive pre‑treatment evaluation ^{[3] [7]}.

5. Why single numbers are misleading: definitions, settings, and time matter

“Went to therapy” can mean informal counseling, mandated psychotherapy, a one‑time assessment, years of psychotherapy, or family counseling; studies and clinic reports use different definitions and time frames. Older multidisciplinary clinic cohorts document mandatory mental‑health screening prior to hormones ^{[1] [2]}, while broad population surveys and reviews focus on outcomes or service use without consistently measuring admission to therapy beforehand ^{[4] [2]}.

6. Competing viewpoints and implicit agendas in the literature

Clinical papers and advocacy organizations both stress the value of psychological assessment but differ in emphasis: some clinicians call for rigorous mental‑health screening to reduce regret and detransition risk ^[2], while advocacy groups highlight that structured protocols and access to care produce low regret rates and that most youth who start blockers go on to hormones ^{[6] [5]}. Political reporting highlights detransition narratives to argue for restriction of care, while medical reviews emphasize low regret and improved well‑being after transition, illustrating how the same studies are used differently in policy debates ^{[2] [8] [5]}.

7. What the sources do and do not say — limits of current reporting

Available sources document clinic practices (e.g., universal screening at the Amsterdam clinic) and summaries of outcomes (e.g., low surgical regret rates in reviews), but they do not supply a single national percentage for “transgender people who went to therapy before transitioning” across all care models and populations ^{[1] [2] [8]}. If you want a single figure, current reporting does not provide it; the best available approach is to cite setting‑specific numbers (clinic cohorts, surveys, or youth cohorts) and note the selection effects and definitional differences ^{[1] [9] [5]}.

If you’d like, I can extract and compare specific percentages from particular studies in these sources (for example, the Amsterdam cohort, the adolescent puberty‑blocker study, or the 2015 U.S. Transgender Survey reporting on service use) so you can see how the rate of pre‑transition therapy varies by setting and time ^{[1] [2] [5]}.