To be frank, I think there are enough BIG problems they still need to work on, that it would not be wise to include new dialogue choices of your character being misgendered.
I kind of dislike the idea of including trans options in a medieval setting already, but for the people that do want to play as a trans PC themselves, I kind of doubt that the majority come to a fantasy escapism game to be confronted more about their identity issues.

This would also have the problem, that many players, including me, might not even intend to be "trans" as a character when they pick female hairstyles etc on my male character. I just like longer hair, and while that is obviously culturally coded, long hair alone will not make people think you are female. I would be kind of annoyed if my Arnold Schwarzenegger Conan lookalike barbarian with long flowing locks and the bodytype of Halsin was first called "ma'am" in every conversation, simply I chose to use a female hair style.

This might be a fun idea if the game was a lot further along than it is, but at this point, I would prefer they write a great general story, fix all the issues still in the game (sneak attack issues, devils sight not working, ...) and just create a great game, instead of wasting a lot of time with little details. I mean, again, while this is an interesting idea, how many people who create a trans character in the game truly even WANT to be misgendered? And would you need to create a toggle for that to not ruin the game for those who don't?