Hi Amoré,
Before you destroy your health from "on again, off again" HT, I think the important issue at hand is; What are you going to do about yourself if you are able to save you're "screwed up marriage."
Saving your marriage is one thing, saving yourself is something totally different. Sadly, you can't have both. It's either one or the other, or a compromise neither of you are satisfied with. Which ever way it goes, your feeling on gender aren't going to go away. Ignored, they will just ascend to unsustainable levels which may result in events you didn't want.
I know you've spoken in the past about your wife holding out on you by way of divorce, and I think you've also mentioned your therapist not helping you much in this situation. That being the case, it appears the choice is up to you.
Sorry I couldn't be more uplifting, but it's getting to a point you may not be able to make responsible decisions.
Keep in touch and let us know how you're coping
Huggs
Catherine