Right now, you’re able to select the appropriate gender marker on your passport without a note from a medical professional (and a passport can be used in the vast majority of situations you’d use a birth certificate) but because the self select gender marker was done by executive action, it’s extremely likely to be reversed when Trump takes office.
Also, having one might be a good idea in general.
is the issue money, or time, or both?
Being disabled it is those things and a lot of other things too, to long to list.