Almost four years ago, I was trying to fight this thing yet again.  I found a gender therapist and when to him to help me stop this "demon" out of my head.
We talked about my past and the things I had done transition-wise and why I had stopped.  He suggested that I "go out with the girls" once a month to help quiet the voice.  Like that would fly with my wife.  So I tried to just be the "man" that she needed me to be.  A year later I tried to take my own life.
It was then that I knew I had to transition, period.  My wife and I sold the house and went our separate ways.  I sought out the same therapist.
At our first meeting , I asked if he remembered me.  He said yes he did and then he said some thing that told me I was finally on the right track.  "I knew you would be back.  It is obvious that you are Transsexual."  

Most gender therapist will use the first meeting as a "getting to know you" meeting.  Then they will get down to business.