Problem: Eknath (Apache for Poet) is a 42 year old biracial (Native American and African American) biologic female, identifies as male, and prefers he/him pronouns. He resides near the Mescalero Apache Reservation in New Mexico. This is a rural mountain community. He presents today with poor sleep, intermittent insomnia, and loss of appetite. For the last several weeks, he reports feeling down and in a low mood. Additionally, he reports difficulty concentrating and thoughts of deaths. Upon further inquiry, Eknath denies an active intent to kill himself, citing passive suicidal ideation, "wanting the hurt to stop" in reference to the emotional pain. Pain stemming from his experiences from others in response to his gender expression.