High magic fantasy, and pseudo-magic Sci-Fi, have no room for transsexuals, because in those universes, changing your form is only a slight inconvenience. Transphobia could still be a thing, those who preach only the pure unadulterated body is suitable to live in for one reason or another, but transsexuals?

It'd be like in the modern day and age someone complaining about a cracked tooth. It sucks to have it, and it'd take, like, a whole day to get it fixed, maybe even two, just the worst, probably even need to schedule an appointment with an expert, and definitely uncomfortable for a few days after as you adjust to the new shape. You just take note of the condition, and if it's really bad... fix it.

But far lefties can't fathom what their day would have been like if they had not had breakfast that day, so they can't possibly fathom a world where the problems they encounter have completely easy and to-the-setting-mundane solutions.