In the Japanese version, Birdo is referred as 'Catherine' where it is also stated that the character is a man who wishes to be a woman. In later printings, mention of Birdo being male was omitted, and further not included in most later games with the character.
The game features a transgender woman named Yasmin alleged to be the player character's former lover, and a gay man named Saied. Usvestia will teach the MUSIK piano technique needed to progress in the game more cheaply to male characters because they 'look cute'. In the English version, he instead says 'He looks smart,' and the gender-based disparity is left unexplained. In an establishment called the Pleasure Dome that caters to gay patrons, among other things. One of its patrons is a woman posing as a man posing as a woman. This game features a woman from a small town who gets a job for a New York paper in the 1920s. Two of the women she meets are involved in a secret love affair.
In the House of Baths at Buccaneer's Den, the player (the 'Avatar') can pay for the services of male and female sex workers, regardless of the player's gender.
