I'm verging into senior citizen territory (or I'm already there, depending on your definition). I've known I'm, ah, "not like other guys" since I was seven. I've considered transitioning twice in my life: once in college, and about a year ago. Both times I've ultimately rejected it, for a variety of reasons.
So how have I coped?
1. Throw myself into work.
2. Avoid personal relationships. With humans, that is.
3. Adopted a cat or two. Or three.
So I'm single, never married, respected at work, and financially secure. And if I dropped dead at home, it might be a week or two before anyone discovered my body.
I've avoided booze & drugs, fortunately. I didn't go the hyper-macho body-building/womanizer/jock route. Nor have I gone effeminate or even androgynous. Mostly just I present as your average computer nerd.
I've never been diagnosed as depressed, and I've never attempted suicide. However, the operative words are "diagnosed" and "attempted." I suspect I've been close to clinically depressed most of my life, and I've managed to muddle through by force. God knows, I'd just love to lie in bed all day, but I simply do not allow myself to do that.
As for suicide .... let's just say that rarely a week goes by without my considering it. I've never attempted it for the simple reason that if I attempted it, I'd damn well make sure I succeeded. When I was younger, I avoided suicide by taking on short term commitments: something to give me a reason keep on living for the next month or two. More recently, I've avoided it by adopting a cat or two. How does that avoid suicide? Because I couldn't live with myself if I abandoned them.