Don’t forget the recent advances in penis transplants (i.e. the fact that they now work at all after transplanting them.).
Of course that line of research and treatments is also, for the moment, mainly directed at young, male veterans and people with severely damaging penile cancers.
To do the same transplant for a FtM male would still be orders of magnitude more difficult. Plus there is currently a “culture war” on trans people going on with those bathroom bills in the US (and parts of Europe too).
Of course even physically the penis is just one thing in order to make it fully functional they’d also need the one thing medical science can likely do, but doctors are very hesitant to actually get involved with and that would be testicle transplants.
Back on the topic of choice games though the old Switch wip was going to play around with the concepts of gender, power and privilege and had it come to fruition I was actually planning on making at least one FtM character there who would have really wanted to usurp the Prince and physically become and stay a boy.