So in a fictional world, there can't be universal healthcare for these kinds of things? It's a fictional world, so not sure why you want to imagine a world to be that terrible to transgender people.
Because the excuse that because it's fiction means that you've solved intolerance by not showing them, does not stand up to scrutiny. As I've said before in this thread, Star Trek humans often pat themselves on the back ended bigotry and intolerance, yet no-one in that universe seems to be allowed to venture out of the closet... or the rule is that it must be kept over there, off-camera and away from everyone else. Because "tolerance".
You think forcing it will make people listen? Look at the backlash at Baldur's Gate for just mentioning a transgender character. You want them to preach to people, but who are you preaching to. The transphobic crowd that would just gonna get pissed? The transgender people that you introduce a transphobic environment into the game? The SJW who's already understanding it? What's the point? You speak out is one thing, making it a social issue in a game is another matter. That's called an agenda. You want to make transgender as characters instead of characters who happen to be transgender. You intentionally want transgender characters for a PSA not to treat transgender characters that are happened to be transgender if your purpose is to "teach" people.
No, you're missing the point... it's not that transgendered characters need to address their status whatsoever, just that if they did, why should it be a problem? Why should their inclusion in the game be denied or glossed over by forcing them to all to be transitioned, as if society demands that for them to gain acceptance?
No-one in-universe and out-of-universe should care if they add a trans character in Mass Effect, why does it matter?
The only people who seem to not want trans characters to appear for those reasons, are those who seem to think that it automatically means they'd be preaching the gospel of acceptance, standing on a soapbox giving a PSA and are written by SJW writers who want to promote an agenda. That's simply not the case at all, nor an adequate reason why we should belittle any trans characters who do appear as supposedly serving this "agenda".
Rather than making it some wild social crusade that Bioware to force acceptance from their audience, did we ever stop to think maybe the intention from the writers was to instead give us a character, then reveal they just happened to be trans?
Mae was introduced in Those Who Speak, but the matter of her being trans wasn't even revealed til the next comic Until We Speak. Even then, it was not done to promote any discussion or even played any role in that story, it something the writers let the audience know, then the story moved on.
I'm not saying those who want that kind of treatment, rather than soapboxing are wrong because they're not, that's how it should be handled preferably. It's just that I detest the notion that we should not include something because it might make some uncomfortable or think we're being preached to.
Why does it have to always be a "message", rather than simply the writers giving us a character with a story and perspective that is different from one's we may have experienced in our own lives... or ones that some in the audience may have experienced themselves?
I'm a straight cis male, yet that does not mean Krem and Dorian's stories cannot resonate with me because I lack the experience of being trans or gay. If anything, it was far the more meaningful because of that, because both characters offered a perspective that perhaps I had not considered before.
For example, I've always seen conversation therapy as detestable, but hearing the sheer pain in Dorian's voice about how he nearly underwent something similar, made me realise how truly horrible it must be for those who are forced to experience that. Until then, it was something I knew existed but had never really thought about as anything more than an abstract. Thus I didn't see his story as "preaching" to me, it was enlightening me.