im an man who will never be sexually fulfilled but i have a smug attitude about it to protect my ego

John, a 50 year-old genetic male, medical research scientist, married (23 years), father of three children aged 20, 17 and 7, phoned me after experiencing a panic attack severe enough to require emergency attention from paramedics at the airport on his way to give a presentation at a conference. John gave me only his first name and informed me that I was the first to be told what he was about to tell me. He said he was "gender dysphoric" and that he was "desperate." Feelings that were once "controllable through sheer force of will," had increased to where he now was having protracted periods where he would close his office door, lie on the floor and weep quietly while curled up in the fetal position, holding his genitals in pain. Other than intrusive and repeated fantasies of being female, he had refused to allow himself any overt form of female gender expression. He reported feeling that if he was to cross-dress and be caught, he would dishonor his wife and family. Having attained international recognition for his work, he was also concerned about his professional reputation. The only other form of temporary relief came through masturbating, often up to five times a day.