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You can't have random dysphoria moodlets, but you could use customizable gender options and cas.fulleditmode to transition your Sim yourself. For example, you could start with a feminine framed Sim, change their identity and clothing preference to masculine, and after a time change their frame to masculine and, finally, their reproductive options.
Unfortunately, yeah, there's "masculine frame" and "feminine frame," but you could maybe bulk up the muscles on the feminine frame and, since you're in cas.fulleditmode anyway, when you switch to a masculine frame have less muscle at first and build up over time.
They do also have pride flags in the base game, including trans pride, so while you can't come out as a base game interaction you can fly the pride flag.
I hope that helps! I do agree that would be an awesome feature and, short of that, perhaps some additional options beyond the binary of 'masculine/feminine" in body shapes?
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