I disagree with there not being any TS, there is quite a bit of dialogue that I doubt the average reader would pick up on as TS unless they're transgender IRL themselves.
Sure it's not any fap bait TS stuff like some other TS stories, but to say the Genderswap disease is just tacked on is some damn strong blissful ignorance imo. When I was checking out the author's social medias, the gist that I was able to garner is that the world Haruki lives in is a bit more open to TS folk than our world is to Trans folk and she wants to try to encapsulate some of the darker stuff while still making some really good fap material.
For context, I think the organ failure line has some Real Life base for it's inclusion in the story, tho I only know of something on that level of severe happening to Trans men IRL wherein there is an increased risk of ovarian and uterine cancers; whereas for Trans women, we have increased breast cancer risks, but that's really only because we have more breast tissue to have said cancer manifest...
That all said, if someone wants a purely more involved TS story, I feel like a porn comic ain't it chief, though I greatly appreciate Dobato's blend of porn and semi-relatable TS/Transgender troubles (Particularly on the clothing and sexuality fronts).