First and foremost I would tell you to absolutely not listen to those voices. That's your self-doubt/self-loathing trying to find ways to dig into your psyche and undermine you. They'll attack you from any avenue possible. Right now you're feeling insecure about your sex drive so they're using that, but for me they've covered everything from me feeling like I'm wasting my life to me feeling like a failure because I don't do laundry often enough. One of my happiest breakthrough moments was going through a depressive episode and realizing that those voices in the back of my head didn't have any ammunition to attack me with because I had been making a conscious effort to address the things in my life that had been making me unhappy. It took years of therapy and effort but fuck was it worth it

As far as the stressors in your life feeling obvious I think that's a very fair place to be. Most people are completely aware of the things in their life that suck and cause them stress on a day to day basis. That said I still think there's a lot of benefit in intentionally thinking through the stressors in your life to understand exactly how they're negatively impacting you so you can understand exactly how you can go about addressing them and either removing them from your life or mitigating their impact. I mean we're all communists here. We know capitalism is barbaric and eating away at us, but we obsessively study it to understand exactly how we can go about attacking it to end that negative process. We need theory to inform our praxis and in a similar way we need to understand the mechanisms that dictate our mental health so we can go about correcting them. And in the process of investigating an obvious problem I often found deeper issues I had repressed and buried that, on the surface level, were things I hadn't thought about in years but on the deeper, subconscious level I realized were things that had been gnawing on the back of my mind ever since they happened. So maybe there's some through line to your feelings of insecurity about your sexuality and there's something there to explore or maybe it's just a particularly gross negative thought that's weaponizing toxic masculinity against you. In either case the best thing I could suggest would be to sit down and think through where those thoughts come from, past experiences that have informed them (positively and negatively), and what you want for yourself in the future. Like I said earlier, just jumping in and trying to address these things without the understanding led me to leaning on ideological narratives of toxic masculinity that I had internalized without ever examining and in doing so only pushed myself further into depression.

Also panic attacks are called attacks for a reason. In the moment your main thought should be towards 'surviving' it, to make liberal use of figurative language. Successful strategies I've used in the past have revolved around grounding myself to reality to stop the anxiety spirals, so doing things like counting objects in the room or playing the "what's something you can see, something you can smell, something you can touch, etc" game that helps keep you in the now and present.