This question always breaks my heart a little, because there really is no easier answer I can give than “I saved everything I could for seven years.”
One bonus I wasn’t counting on back when I started saving was that several national insurance plans (and indeed, a lot of big companies’!) started offering coverage for bottom surgery, IF it was determined to be “medically necessary.”
Not that getting HealthPartners to agree with me was a walk in the park, either– it took literal months for me to get ahold of people who could tell me what exactly I’d have to do to prove it “medically necessary,” but in the end, my Insurance ended up paying $45,000 of what would’ve otherwise been a $50K bill. *Much* more reachable, and they only changed their policy in the last couple years. I do hope the tides keep changing in this direction for more companies.