lore-friendly transitioning methods

[Cleretic]

It really wouldn't make much sense for them to pursue HRT and surgery as an avenue for gender transitioning except from a "pursuit of knowledge" angle. In a setting with magic that's been worked out to a science, considering magic is easier, quicker, more comprehensive, and easily reversible if the patient isn't taking it as well as they thought...

Hormone therapy is not only for transitioning; all the drugs used for transitioning in real life are more popularly used for other things, they just happen to also do the thing that trans people need.

If pregnancy and menopause aids exist in this world, then feminizing HRT methods would do, because they are the same thing. Like I said before, I don't think that the general scientific level of the game world is far enough to understand hormones specifically, but they would absolutely be at a level to understand 'X substance causes Y biological effects that is good for Z type of person', even if the why of it isn't fully understood; at this point it would be folk medicine, but that's still medicine. Ironically, hormone therapy in real life does sort of predate understanding of hormones itself like that. Maybe the answers are magic, but maybe they're not; again, Garlemald figured out pretty good surgery, and maybe magic covers this in ways that we've never seen. (And yes, Fantasias exist as so many drive-by posters seem so proud of bringing up, I have mentioned before that they aren't a strong answer.)

Personally, though, my inclination is that the medicinal approach is the most likely non-surgical option to exist; while we haven't seen that either, the ALC/CUL storylines from Shadowbringers onward does show enough of an understanding of medicine and nutrition for me to believe that bodies work that way, and that understanding of medicine is at enough of a level to connect points A and B like that.

Unless you're trying to shove a real-world transgender drama plotline into a setting where it's really both unnecessary (this is a heroic fantasy story) and moot (surely magic to facilitate this exists), it would be pretty pointless for Sharlayan to have information on HRT and gender reassignment surgery. (I mean, they probably do but just for hoarding purposes, not because it's practical or necessary for the most part when magic exists.)

But here's the more critical thing: If someone is asking the same question as the OP, yes they want an analogue to the real-world trans experience. This is neither 'shoving', 'unnecessary', nor 'drama'; this is people wanting to reflect the reality of themselves and people they know, either in roleplaying, fanwork, or just their own personal conception of what this world is like. Yes, it is not the focus of the game, but this story's got an awful big world in it that both gives space for a whole lot of stories outside of its main focus, but that the game world itself is big enough to accommodate such a thing existing. After all, while they've never directly addressed the concept of trans people in this game, Sadu sure got really close!

If your response to people wanting to see themselves and the healthcare they need depicted in the game they like is to describe them as 'shoving unnecessary drama' in, this discussion is not for you. You cannot have the answer to a question that you are rejecting.