Advice on coming out

So I'm in a bit of an odd situation when it comes to me coming out. So overall, there is no actual risk in my life for me coming out. I own my house so I have no concerns about being kicked out or at something. I work remotely and rarely have to turn on my camera so that isn't a concern. And lastly I'm 99.99% sure that my parents and siblings already know (there is a lot of reasons I think they know but the big one is my sister straight up asked me if I was taking estrogen because my parents think they saw a vile in my house).

But even though it seems like I am in the perfect situation I still can't come out and I feel like I never will be able to. When my sister asked me, it was the best situation since I didn't have to bring it up myself but I still just froze, denied it and played stupid.

And this really sucks because of I don't come out to my family then I can't get the surgeries I want since my therapist knows I don't have any support system for the surgeries if I'm not out.

It's hard to even address this with my therapist because it feels so impossible that I don't even know where to start. So does anyone have any advice for this or am I forever stuck?