So I beat the game and the side quests.
Really the only trans person in the game is a side character named Claire. She looks like a normal, nearly middle aged woman. She casually mentions a gender transition in a quest as matter of factly and there's a trans flag on her dead husband's car.
The criticism I've seen otherwise is the mix it up ad which is about mixing drinks and has a trans woman on the ad. If this were the only raunchy ad it would be out of place, but I guess there's nothing unusual about the orgasmic drink, a dude fucking a woman missionary with legs up about lasting a long time, snakes going into wide open asses, some dude being on top and an ass ramming into his face, there's also gay ads.
They're just looking to be insulted. Fuck em.