I hope this new T works out.
I can relate to the self-harm piece, but it is very much linked to childhood sexual abuse.
I agree with Bill, the fantasies are not part of normal childhood development. It's not a guarantee that there was csa, but it is definitely not something that most kids fantasize about... I would also say that the triggers for the self-harm are somewhat indicative of at least some sort of trauma, but I wouldn't recommend digging for memories. Definitely something to explore with a therapist.
When you talk to your new T, it might be a good idea to ask how versed they are with gender identity issues, self harm, sexual issues, and maybe also versed in abuse issues (as well as not pushing to discover them)...
I'm not sure how much choice you have in T's, but hope you can find some help...
If you want to talk about the sh more too, you can shoot me a message. I'm ok talking about it a bit here too if that's more comfortable for you...