A psychiatrist is a type of specialised doctor. Their job (when actually done correctly) is to listen to symptoms, perform tests to excluded non psychiatric illness, develop a diagnosis and prescribe treatment like medication or ECT/TMS etc.

A therapist, a counsellor or a psychologist is someone who talks regularly and uses talking based therapies like Cognitive behavioural therapy CBT (yes the same acronym) or dialectical behaviour therapy DBT or eye movement desensitisation and reprocessing EMDR to treat conditions. These people should have some sort of qualification as a psychologist (or social worker or something not crank)

I think a therapist would be your best first step. If your doctor or the therapist had ambiguity as to diagnosis or treatment then seeing a psychiatrist.

The safest way I’d phrase it is you have unwanted intrusive thoughts of dying, that conveys how distressing this is while reassuring you’re not actively about to do something dangerous.

As already explained, a psychiatrist is generally an MD who can prescribe you medications - usually they stick to psychiatric medications like SSRIs, ADHD meds, yadda yadda. I wouldn’t be surprised if some psychiatrists also do gender health.

If your GP is a good one, they will take suicidal ideation and/or intrusive thoughts seriously and set up a consult for you with a specialist- or at least give you a number. Having intrusive suicidal thoughts is a serious thing to go through and from the things you’ve written, its obviously distressing to you. It can be hard to screen someone for suicidal thoughts, some people are more passive and others more active. Some people have the equivalent of something in their heads screaming at them to do it (not a hallucination necessarily, I know exactly what you mean when you said it) but they dont actually want to die. Im a nurse and do lots of intake, I always ask people straight up if theyve had thoughts or a plan to actually kill or hurt themsleves or if they’ve tried to before. I also ask if they’ve ever had thoughts of wanting to go to sleep and just not wake up (thats more passive suicidal ideation). I ask them, if they’re positive, for either that if I gave them a button that simply let them cease to exist and I left the room, they had time to say goodbyes or whatever, would they push it? That can tell the difference between active and passive.

I dont know what kind of therapy would be most valuable for you, thats up to your healthcare team (which includes you). I suspect some version of CBT would probably be the most beneficial. CBT when done properly has homework, its not just talk it out for a couple hours then wait a week. You have to work on identifying “automatic thoughts” and track them and write them down.

I took medication to help me deal with my darkest lowest point, and I ended up on it for about 18 months. I really valued it, it helped a lot with suicidal thoughts and my emotions. But after that long, a lot of stressors were gone (I graduated, got a job, had long broke up with my ex, etc), I had done a lot of therapy, and I felt ready to stop taking it and tapered off slowly for about 4 weeks. You may be advised or prescribed to take something like Effexor, like I was, if you do give it a fair shot to kick in before asking to switch. They take a while to come online, about 3 weeks is typical.

Psychiatrists write scripts, but you generally don’t talk to them outside of “yea I’m still feeling like shit” and them asking you what you want to try for your meds. Therapists talk to you about your problems and work with you to give you skills and set goals and stuff like that.

You can mention it during a check up or whatever, they aren’t going to have much to say though.

You could tell them you’re having passive suicidal ideation (no plan, no method, etc) and its fine. They’ll prolly give you Prozac and recommend you go to a therapist

In the US, I’m not 100% sure where you are in the world but I think a lot of this carries over across healthcare systems. Big difference would probably be what exactly you have to say to get sent to grippy sock jail