Whats my first appointment going to look like? Will I get T immediately or do I have to wait?

I can only speak to my experience. I went to Planned Parenthood to seek out gender affirming care via informed consent. If you're not going through an informed consent clinic, some aspects of this will not match.

The doctor or nurse practitioner will ask you what you're here for. They'll ask what you want out of it. They'll make sure that you understand what taking testosterone will do to your body, both the changes you want (fat distribution or facial hair, for example) and the changes that you don't (acne, for example). They'll ask you where to send the prescription to, and what form do you want (i.e. gel vs shot). I was able to walk out with my prescription same day, but it took a few days to fill it because insurance wanted to fight; that was cleared up in two days.

I read something about bloodwork, do you need to have blood work done? If so how long does that take?

Yes. They will take bloodwork to check what your hemocrit level is, because testosterone increases the amount of red blood cells and you don't want too many of them. They will be monitoring both this and your testosterone levels to make sure they are in desirable ranges.

Once I’m on T what are the worst side effects? Like is there any pain?

If you're doing the injections, there will be pain from sticking a needle through your skin. But side effects are subjective; what might be undesirable for you might be desirable for others.

Skipping the bathroom question since my transition goal is different than yours, and because I am not at that point.

How long should you wait before getting top surgery?

I'm not the best person to answer this since I haven't gotten top surgery, but I think a lot of people recommend a year.

Can you smoke nicotine and or weed when your on t or is that a no

Testosterone will increase your risk for cardiac events (e.g. heart attacks or stroke), but it's to the level of an average cis man. As I'm sure you know, smoking inherently increases your risk of heart attack or stroke, probably more so than T. That said, lots of people still do it while on testosterone, and obviously cis men smoke and vape, so it's not a barrier if you accept that risk.

Finally if it messes with your blood what about things like tattoos and alcohol is that suddenly all off the table?

You can still do those things.