I've been keeping a log/journal since February 6th of my answers to the common depression questionnaire (PHQ-9) in order to determine if I needed to actually get help or not. After a few weeks it became clear from the sea of "yes" answers that I needed medical attention. On February 23rd, I went to the doctor and was quickly diagnosed with Major Depressive Disorder (Severe, Recurrent) and had my antidepressant dosage tripled. Soon after, I made an appointment to see a therapist and got in to see her yesterday for the first time. Unfortunately, my insurance does not cover mental health services AT ALL, so I am paying out of pocket to see her ($120 per session). While I have always battled anxiety and depression, I know that part of this rapid descent into darkness is being driven by the fact that gender dysphoria is eating me alive. I've only told my wife so far and am having a hard time coming to terms with it. My wife tries to get me to talk about it, or will call me by my male name, but I haven't been able to consistently comply. I grow ashamed or further depressed. That said, the logical course of action would have been to tell my therapist about this at our first appointment. Unfortunately, when she asked me if I could identify any stressors in my life that could be contributing to the depression, I could only provide answers that are generally expected (just started graduate school, just got married, just moved, etc.). When I tried to say anything related to gender dysphoria, my brain seized and I literally couldn't speak; like I simply forgot how. I just looked at her and shrugged as if that was appropriate punctuation for the end of my sentence. I even tried to get it out a couple more times, but the same thing happened. I feel like I am just wasting time and money if I don't tell her. I don't know what to do. My mental health is honestly declining (I've marked "yes" to the question, "Thoughts that you'd be better off dead or hurting yourself" all but three days since the 6th) and I'm feeling the pressure. This is such an expensive line of care that is putting financial stress on my wife and I, and I'm falling into the mentality that I am just honestly not worth all of this trouble. I've really started isolating myself from the outside world and almost obsessively appraise my relationships. When doing so, all I can see is all of the effort and energy everyone else is putting into them and I can't see how they could possibly be getting anything out of interacting with me. It's getting harder and harder to keep myself afloat. Apologies for the long post. It's been a while and I am really stuck. Please help.