Presto. When paying out of pocket, Adam can get out of that therapy/letter requirement by going to a surgeon who practices Informed Consent. http://www.topsurgery.net/surgeons/informed-consent.htm

Crowdfunding has had good results for many trans guys raising surgery money. However, for every successful campaign there are hundreds more that barely get out of the gate. Asking people for money is a skill, and it requires that one have a good network of people who could help financially, or the ability to create that network. If you're just starting out with crowdfunding, here are some tips to help maximize your efforts:
http://transguys.com/features/surgery-fu...owdfunding

Hope this helps!