Yeah for sure, I mean that's the beauty of Magic. The reality is that a lot of stuff is already present in the backcatalogue of the Realms if they did a little legwork. D&D has been on the inclusive side of the culture wars for a long time, so we know there's a fit, and in literature more widely these are things that have interested humans for ages and ages. And its not just about sexuality, or dress, or comfort in one's skin, but power too. Not so much in Dungeons and Dragons of today, but surely in the the sorts medieval or ancient societies it borrows from and builds itself out of. There were pretty obvious reasons that a woman want might to be man and hold power in times like those. Like you know Agrippina would have wanted to be Caesar herself, if Locusta had only had the right potion hehe.
But going back a little further you can see the reverse too, if only vestigially. Like when obviously the Sky Gods wanted what the Earth Goddesses had, given how pretty much every early myth cycle cracked off. Probably more than a few priests wishing they were priestesses in whatever period preceded, just for pure power motivations. But yeah, the game really doesn't need to be that complicated with it. They should just provide a cool point in the story where the PC is offered a choice. A magical choice, that they can either pursue or ignore, as their interest dictates.
The genius of Edwin in BG2, is that they threw that belt in there kinda casually, as casual as a polymorph can be at any rate. They handled his metamorphosis conundrum like proper thracian witchraft, like Lucius, like oh shit this is a story worth checking out! And so it worked and the character remains celebrated. Ahead of his time. There was an element of choice to it too, after the initial questline, that left the door open.
Plus I think if Bioware had actually commissioned a proper female portrait and voice set for Edwina at the time, I bet like half of everyone would have elected to have him remain a babe for the duration. Clearly he was getting into it, and discovering things he didn't know he didn't know haha.
Edwina custom portraits and voice sets probably got hacked into the thing by more than a few Shadowkeepers, but it would have been nice if they had actually built it into the game on the first pass. Took another decade and a half for the Enhanced Editions to fix that issue, or maybe it was just a mod? I can't recall. But anyway, they handled it with style.