You asked if there are therapists who "help with this". Of course, not knowing what it is you're dealing with, that's difficult to say specifically. But, in general, I feel it would be safe to say there are therapists who deal with (or at least think they can deal with) pretty-much anything. Occasionally one may find a therapist who feels unqualified to deal with a particular concern, or perhaps simply has some personal reason for not wanting to work with a client who has a particular concern. But, if one keeps looking, it seems as though one can find a therapist who is willing to work with any issue.

Being a person, myself, who has dealt with a lifetime of issues related to gender identity and sexuality-related issues, my personal experience has been it's not difficult to find a therapist who's willing to "take you on", so to speak. However, finding a therapist who can actually be of help is another matter. In fact, my personal view is one has to be careful because a therapist who isn't trained as well as experienced in working with a client's particular issues can do more harm than good. So it can be a tough "row to hoe", as we used to say, to find the right therapist for one's specific concerns. And my personal prejudice, I guess you might say, is that this is especially true when one is talking about issues related to gender identity and sexuality-related concerns presumably due to the long history of prejudice that existed (and in some cases still exists) with regard to these sorts of concerns. Of course, where a person lives comes into play here as well. If one lives in a major metropolitan area there are going to be more options available than if one lives in a small town or rural area.

By the way, you mentioned that even though this is anonymous if you came right out and said what it is you're dealing with, you would still be a pariah. I can't speak for others here on MSF, of course. But as for myself, having lived an entire lifetime hidng my gender identity issues as well as harboring predilections that would nowadays place me within the ABDL community, I don't believe there is anything you could divulge that would shock me or cause me to consider you a pariah. And I have to presume there are others here on MSF who would feel likewise. Just sayin'...

One thing I do know about intimately, is what hiding these sorts of things, over the course of a person's life, does to them. It eats a person from the inside out. I know because I've lived it. As you wrote with regard to being gay, years ago it may not have been illegal, but being outed could have caused one great harm. When I was growing up, I learned very early in life (I don't know how) that there were things about myself I must never breathe a word of to anyone. And to this day, to a large extent, I never have. And also, to this day, it continues to eat me alive from the inside out. I've tried seeing a few therapists myself. But it never amounted to anything. This is probably, to a large extent, my own fault. But when one has spent their entire growing-up years being taught over-& over again "you don't wash your dirty laundry in public", and then, as an adult, living for decades surrounded by people who would be aghast to learn about what is lurking inside the facade I created for myself, it's not easy to change. Still, I do hope you will try because continuing to live with the type of secret you allude to is dreadful. And besides, as you mentioned, you've never acted on whatever it is you're dealing with. They're simply thoughts that keep relentlessly swirling around in your mind. And there's nothing to be ashamed of in that. In fact, from my perspective at least, there is a certain badge of honor that goes with (or at least should go with) harboring the type of secret you've apparently been struggling with for a long time (perhaps a lifetime?) yet being able to resist acting on it for all that time. Please try, if you can, to reach out for the help you need. My best wishes to you