For me it is a little more complicated.
I started seeing a psychologist for stress and depression (my old work paid for it) in 2009/2010. At the end of my second session with her, I mentioned that I liked to dress in womens clothes to make myself happy. In my third session, I came out and said that I wanted to be female. Over the years, I probably had another 15 to 20 sessions with her. However, she was not experienced in gender related issues, and three quarters of my sessions with her were about gender issues. On her urging in 2010, I went and saw a doctor who gave me a referral to see a psychiatrist. Had three sessions with him over the course of a couple of months, did not like him, and stopped ALL therapy as a result.
In 2012 I started seeing my old psychologist again, on and off. In March this year, she suggested that it may be time for me to seek more specialised help again. So went to a doctor and got another referral (haven't used it), but found ANOTHER psychologist who specialises in gender issues. Had one appointment with her, and she diagnosed me with gender dysphoria, and saw no reason why I couldn't start hormones. She outlined what needed to be done. I had another appointment with her, an appointment with her colleague, an appointment with a doctor. Got my bloodwork done, went back to the doctor, everything was fine except for my weight and blood pressure. He gave me two weeks to get my blood pressure down to an acceptable level, and to try to lose some weight. Went back after two weeks, saw the doctor again, we mutually decided to hold off for another month on the anti androgen he was starting me on (Androcur), but after discussing some things with him, he started me on a low dose of finasteride. When I go back to see him in about three to four weeks time, with any luck I should have lost a few more kilos, my blood pressure will be steady, and I can start on the Androcur. Estrogen may be a few months off, as I suspect I may have naturally high levels already.
So, in summary, I started some kind of therapy where my wishes to be female were discussed, in 2010.