I am not bothered by either the inclusion, or the exclusion of things like this in games. Take note that I am partly not just talking about something like transgender options here in a game, I am talking more general with things related to people in general and what not... but... due to that, what I say does include things like transgender, amongst alot of other things (even the "norm" and most common things I guess), etc.
If it is in a game, then that is great... gives people the option to play what ever they want, and/or experience such things in the game. I don't feel that you always have to have stuff like this in every single thing... especially not if it is just there for the sake of having it in there... but also feel that when it is in, and it has been done well, then it can enhance the experience of what ever it is.
If it is not in a game, then that is a shame... since it gives people less option, and/or less opportunities to experience such things in a game. But...like mentioned, I don't always feel that you absolutly have to have every thing in there for something to be good or what ever. Also... I don't judge the games or the devs because of a lack of X, Y or Z thing, since there can be multiple valid circumstances as to why various things are not in a game (be it anything from there just not being enough time and/or money to actually include it (to me this does partly depend on the project, and size of team, their timelimit to release, etc), or just a general lack of actual knowledge about a topic so that it would not feel right to add it due to a chance of representing it wrong, or that it might just not be fitting for the setting for one reason or another, and what ever else it might be, etc.
I guess the only thing I really ask for when it comes to these things, when they are in a game, is that it's atleast done in a good way. I don't know exactly what that means though, to "do it in a good way"... that could mean almost anything. But I guess unless it is supposed to be a defining factor of a character, that they are "X, Y and Z" (no matter if that is the most common thing people are in general or on average, or if it happends to be something which a minority amount of people are)... don't make to much of a deal about it, because it is compleatly unnecessary to constantly refer to it over and over and over again if it is not a defining factor to who the character is... something as simple as an NPC (no matter their perceived gender/etc) saying something like "Yeah, we'll do it... me and my husband/wife/boy- or girl-friend/partner/etc are going to go and fix that for you now." would be enough I feel to give the players a clue as to who the character might be in one of the aspect of them.
I don't know how the best way would be to include something like transgender to NPC's in games with out the game constantly hitting us across the head with a hammer about it... because unless it is supposed to be super obvious that someone is transgender, there is a chance that you might never actually know that a person might be transgender. I mean that is true in real life as well, where there is a chance that you never knew that someone is transgender until the person tells you they are, or someone else points it out to you. Not compleatly sure either how much effect the fact that your own character could potentually be transgender should/would/could have on the game in general... if the game should in some way take note of it (no matter what you are, be it male, female, transgender, or anything else), so that some NPC's in the game might mention it, or that it might work for or against the player character in some occations... or if the game should not take note of it at all, where it does not have an effect on the game at all.
I don't know... there are better people then me to figure things like this out... because while I am totally behind the thought of equality for all, no matter who you are, I am not a person who will directly get involved in matters like this very often (or alot of other importent things as well for that matter)... partly because I am not a very social person at all (and as such I usually only have enough "social energy" to deal with social stuff in my own main interests), but partly also because I might not actually know a lot about the subject in general (and don't feel a need or interest to dig deeper into it... which comes from the fact that I do have Aspergers, which means that my interests are a very limited set of things, and if something is not really in my set of interests chances are I won't feel like spending a lot of time on it). The way that I get behind things like this is by maybe once going "Yes, good... this thing is something which I fully/mostly stand behind" (like I am partly doing with this particular topic here), and with my vote if a vote is required to get things going/changed/fixed... other then that, I stay out of most things like this. XD
Anyway... it's a good thing, but I don't know what would be the best way to implement it... I guess that is all I have to say about it for now... XD