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.
Well, I hope things get better. I can suggest all the obvious things: find a local mutual aid group to raise the $200 for the passport fee, I think right now a lot of liberals would love to support a trans person in need. Maybe you have friends or family who would be willing to help, but even if not there might be a local trans community you could try to connect with and they might be able to help or know people able to help.
Either way, I understand if the challenges are too great - some things can remain perpetually out of reach.