The only way without therapy would be to pay out of pocket. Which will be cheaper than in the US, but you still pay five figures for vaginoplasty.

If this is not an option, you could find a private therapist, 12 sessions are still less expensive than putting down 20k+ € at the clinic. They usually have much shorter wait lists. Otherwise, it can take up to a year to get a slot in, if there is an open wait list in the first case. Systemic failure is everywhere in German trans healthcare, although i'd say it's even worse in the UK, Netherlands or Denmark (basically any place that bottlenecks treatment through gender clinics).

Apart from the therapist letter, you also need a letter from your surgeon that you've had a preliminary talk, are informed about the procedure and that there are no medical concerns that speak against the surgery. You should make an appointment for that as soon as possible, because they have wait lists for that as well. Some clinics like Lubos will only send out the letter once you have the one from your therapist, but you can book the appointment before that.

Finally, insurers also demand that you rule out being intersex (there is zero scientific reason for that, they just love openly discriminating gender diverse people). This is done either via an ultrasound at a gynecologist or urologist or via chromosome analysis from a blood sample. I went for the latter and included it with a letter from my endocrinologist about my HRT progress.

That's all the paperwork that is obligatory, but sadly it doesn't always end there. The MDK (the agency that gatekeeps this stuff) is also very likely to ask for other things which are even more bs than the other stuff. Examples include: A trans CV written by you, reports from therapists, day clinics and rehabs if you've had any mental issues in the last years to prove that you're mentally stable, the letters from the two forensic psychiatrists you had to see for your name change if you had to undergo the TSG crap, or other assorted nonsense.

This sounds like a lot, it is a lot and it's draining af to go through that process, but the MDK is mostly just playing pretend with this. They approve almost everything, but it's sadly a very normal thing that they only do that on your second try. Do not let these fuckers scare you away. They're dumb as rocks and more bark than bite, but this process is an annoying additional 2-3 month delay.

A far as surgeon wait lists go, these vary a lot. I don't know how quick you'd get an appointment if you pay yourself, but if you go through your insurance, Dr. Meister in Mannheim ist the quickest out of the big names rn at under a year of wait time. Morath & Schöll in Munich are at 18 months wait time. Uniklinik Essen is the only place that offers PPT (peritoneal pull-through) as an option, but has the longest wait list at 2-3 years, and you will have to wait a year just to get a preliminary talk. Lubos Klinik and Dr. Taskov in Munich and Klinikum Essen Mitte are somewhere in between these wait times.