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Historically, Samtse was sparsely populated as the mountain-dwelling Bhutanese considered the low-lying district to be prone to tropical disease. During the early 20th century the district experienced a large influx of Nepali people who were invited to the area to assist in forest-clearing. Overall the district population has recently been increasing and there have been housing shortages in Samtse as reported by Kuensel.

Samtse is also home to the Lhop (Doya) people, a little-studied ethnic group of approximately 2,500 persons. The Bhutanese believe them to be the aboriginals who predated the Tibetan migration from the north. The Lhop are noted for their animistic religious beliefs, their practice of marrying cross-cousins, and their unique burial customs.