Your access to hormones and surgery, and the steps you need to take to obtain them, are determined by both your state laws and your insurance company policies. Either your state or your insurance company may require you to be diagnosed with gender dysphoria in order to access hormones and/or surgery. In other cases, you may not need this diagnosis in order to obtain these services. Call your insurance company to see what they require, they should be able to give you all of this information.