I am literally showing you the text of the law, in what way am I “misinformed”
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Obviously, yes, there's physical symptoms too -- back pain, itching, sweating, chafing, all that good stuff That's a spectrum of stuff that happens to anyone who has breasts, and how much it bugs you and whether it's "worth it" to have surgery is a matter of opinion
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(And, yes, a matter of gender identity You'll notice that if a cis man has breasts at all and they bother him they just go ahead and call it "gynecomastia" ("breasts like a woman") and approve medical treatment regardless of whether they're "macro-" or "giganto-")
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it should be noted that having breasts to heavy for your frame to support can actually lead to fairly serious medical issues, so it isn't completely arbitrary.
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though from what I understand there usually is a ton of gatekeeping unless you meet a certain size threshold or have already developed spinal problems and whatnot.
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And the diagnosis criteria to get covered by insurance is basically whether your back and shoulders hurt and it's not improved by physical therapy, which is frequently a question of there not being bras on the market that fit because the bra industry in the US is shitty.
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There's also a whole discussion to be had about surgeons refusing to go as small as people ask for, which is a frequent complaint on reddit, because plastic surgeons are more concerned about what future male sex partners might want than what the woman getting a reduction asks for
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There's another complication, which is that it's hard to find a good size range of bras in many parts of the world. Victoria's Secret doesn't cut it. Many people suffer in 38DD when what they really need is 30HH, but can't get the right size because it's not available.
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Most bra shops carry around 20 - 30 sizes, but that doesn't reflect the needs of the population. The average bra size is around 32FF / 34F, but most shops don't even carry that size, even though it's at the top of the bell curve. A comprehensive size range is around 190 sizes.
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I once consulted at a plastic surgeon's office, where particular middle-aged men brought in underaged "daughters" for breast enhancement surgery. Everyone knew these minors weren't daughters, but they were waved through the process because $$$. Making boobs LARGER? No problem.
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