I think it depends how the material is presented. Homosexual and transgender people exist; get over it. Conversely people do play games to be immersed in a story, and if the story is put on pause for a PSA on transgenderism it can be a groaner. I read that mastectomy scars are an option and that goes further than transgenderism. A lot of cis women unfortunately have to have the surgery for life-threatening issues and even if it's not part of the story I'm sure the acknowledgement means a lot to those people. The game has a solid 71% positivity rating on Steam so the people annoyed by this are probably the same 30-33% that think using "cis' is hate speech.