I've only visited China, and my chinese freinds haven't talked about this issue before, so all my experience is from the chinese internet. I would be interested in a more in depth analysis if it exists.
I've only seen one person on Rednote talking about trans issues openly, and they were careful to make their content primarily in English. They claimed that making the content in chinese would get them more online harrassment which they didn't want to deal with. It's not that everyone is a problem, but there are enough of them to make it very unpleasant. While transition can be legally done, requiring surgery as others have pointed out, it is still difficult socially.
This same creator had one video where they pointed out that younger people are generally more accepting, but not universally so, and older generations are rarely understanding or accepting. That being said, they do make it clear that the culture is shifting, it's just going to take time.
Regarding same sex couples, it's a mixed bag as well. The media has to skirt around explicit relationships much of the time, but will include very heavily coded characters. There was the legal case a year or so back regarding the rights of same sexual couples as it relates to their children. There was a post here on lemmygrad about this a while back. The relationship was not considered legally relevant in that case, but they did rule in favour of the children being of both parents because one acted as a surrogate. There's some hope there, but it's a long, long way to go.
I'm hopeful that we'll see things change in the next few decades as in Vietnam and Cuba, but that's just vibes. It could be better, but it's certainly not the worst in the world.