Hello Agenders: Have you seen an experienced gender therapist? If you're feeling "really gross and ashamed" & you're having recurring thoughts of self-mutilation, you need to see a professional gender therapist. Therapy is required for transsexual persons who are transitioning & want to have gender reassignment surgery. And also, the kinds of thoughts you're having now, if left to fester, can lead to major depression, generalized anxiety disorder & self-abusive behaviors. So, at this point, my perspective would be that the first thing to be done would be to get going on some therapy. My best wishes to you! (Keep posting here on PC too!)