Surgery:
Most surgeons require people to have been on hormones/ lived in their gender identity for a year or two. Your therapist (and sometimes a therapist with a PhD) will have to write a letter explaining that you have dysphoria, that surgery is medically necessary, and that you understand the risks and benefits of surgery. Do your research! This is a serious decision; make sure you're comfortable with the surgeon you pick.
Some insurances will cover surgery, but many surgeons don't accept insurance.
Some insurances will cover surgery, but many surgeons don't accept insurance.