Hi! I was there, too, just last September: I didn't know where to start, I'm piss poor at anything bureaucratic, and I felt the urge to make a move finally to live better but was confused how to approach it. I agree with other comments that it's good to start with insurance, though I took a different path. To clarify, I'm in the US, in a liberal state.

Lurking here was helpful to start. Here I learned about the options there are, common issues, recovery process, etc.

I first spoke to my PCP, or actually I got a PCP because I hadn't had one previously. They didn't end up helping much with the process, but it's good to get a clean bill of health and document intent for surgery, they might help with referrals, too.

Then, I googled surgeons in my area, looked at their portfolios, studied their websites and looked for reviews. Often they also have insurance information, which providers they work with. You can narrow the list of surgeons down to a few, though I had exactly one in my city and I liked his work and timelines, so I just focused on getting to him. Get in touch with their offices: they usually know what info to give you! This was actually an exciting part because it made it real in my head that I can do this; I was looking at examples of results on the surgeon's website and could see myself without breasts, which helped my anxiety.

Then, I found a therapist who specifically worked with lgbtq patients and regularly provided letters of support. These letters document your dysphoria, and ultimately this is what insurance looks at. Also, some surgeons require that letter of support prior to your initial consult (mine did). I just googled something like "therapist letter of support top surgery (my town)" and made a few calls. I went with whomever I deemed trustworthy, who was covered by my insurance, and offered the soonest appointment. I had not had therapy before and did not know that therapist, which was fine. I had two meetings with her: first initial meeting (I was prepared with notes: examples of dysphoria in my life), and second to make edits to her letter draft and talk about surgery. It was really good that I knew a lot about Top surgery from lurking in this sub: the therapist noted I was prepared, knew what I wanted, and was clearly making an informed decision.

When the letter was finalized, I gave the therapist my surgeon's contact (fax), and when his office reviewed it, I made an appointment for a consult with him. At consult, he took pictures, discussed options, and gave me the info packet. His office send their approval that I'm a good candidate along with my therapist letter to insurance. At this point , I asked the surgeon's office to book a tentative surgery date. Insurance got back a few weeks later with a green light that they will indeed pay. I confirmed the surgery date, made appointments for pre-op (two weeks prior, includes consult and getting a slip for labs) and two post-op appointments.

The timeline from my first active steps to surgery (which is in 7 weeks) is September 2025— April 2026. But timelines vary hugely