Those with GD (transsexual) it is believed only represent 2% of the transgender pot. Within this group transition is often not the first choice....counselling, CBT etc. is also used.
For me, medical transition was the last resort after seeing multiple psychiatrists, psychologists, and counsellors. Insofar as CBT, its only real value was to limit self-harming/negative behaviours - not to tackle the GD itself.
When I was a kid, there was no Mermaids or similar. I ended up seeing a child psychologist/educational psychologist, but even if there was "a Mermaids", my mother - who was a very sensible and pragmatic woman, would have never fallen for this "new ideology". She thought I'd "grow out of it", and happily supported my GNC (probably thinking I'd grow up to be gay tbh).
The problem is that with "true" GD, it doesn't "go away", it just gets worse - no matter how many mental health people you end up sitting in front of or how many coping mechanisms get thrown at you.
And as a side note - the most unhelpful question these people love to throw at you is "...well do you 'feel' like a woman?" - to which my answer is always "what does a woman feel like? I feel like 'me'..." - at which point they try to drill down to hackneyed old stereotypes.
HOWEVER, when everything else fails, a medical transition IS the only way forward - and as I've said in previous threads, the GD never truly goes away even after transition. It's eased dramatically, but it still "sneaks up" on you when you least expect it.
It's a disgusting mental illness. It's all-consuming and all-pervasive, and at its worst makes it nigh impossible to function on both a cognitive and social level.
Be under no illusion - taking hormones carries significant risks: The HRT can cause blood clots, strokes, heart disease, and the anti-androgens can INCREASE depression, cause suicidal ideation, bring about anaemia - to name but a view. Any good Dr will schedule regular blood tests to monitor kidney/liver function as they're the first to be put under stress.
I think this is ONE (there are many) of the reasons I get annoyed at the blue-haired "gender feelz" brigade - who just trivialise GD into (paraphrasing) "I feel like a woman so I am a woman". It's that "aquisition"... and that's not what GD is. They see the "journey" as a fun little jaunt full of dresses and lipstick and fluffy kittens but it's anything but. It's more like Sisyphus rolling that bloody boulder up the hill.