This is an individual matter. Since massage is a "hands on" experience, it necessary to gain access to the body. Although clothing may hinder some types of massage, the comfort of the receiver is the prime concern. Some issues involved are a need for trust, warmth, a sense of safety, and at times modesty. The options of top sheets and the ability to work around some clothing are available. Since your needs are an essential part of massage, it is important for you to communicate your preferences. You can find that as you develop a working relationship with your massage therapist that your comfort level will grow.