One of the creative decisions I made wrt my Omegaverse(s) is that, at least in the modern day and for most people, being trans on the male-female axis isn’t really that big of a deal. Usually, the perception is somewhere along the lines of “harmless quirk” or, at worst, like someone who gets a bunch of plastic surgeries to correct tiny bits of their appearance.
(Like; it’s weird that you care so much about such a tiny thing, but okay, you do you.)
(This is probably helped by A: the male/female distinction being almost completely irrelevant and B: that the vast majority of people, at least in M’s Omegaverses, are cis-by-default on the male-female gender axis.)
(Also, in some universes, people who are trans on the M-F axis and people who are trans on the A-B-O axis aren’t considered the same thing. The A-B-O axis trans people are trans and the M-F trans people are something else.)