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The current study investigated the service access pathways of transgender youth at a mental health clinic. Demographic and service information from youth (aged 17–25) at a Canadian mental health clinic (n = 1,504) was collected. Four separate chi-square analyses were conducted to measure potential differences in service access between cisgender and gender diverse clients (those identifying as transgender, gender queer, non-binary, or other). Compared to cisgender clients, transgender and gender diverse clients were significantly more likely to self-refer for treatment. These findings highlight the importance of a self-referral option for young gender diverse clients and provide needed data about the mental health service access of transgender youth.