Character creation includes an expansive list of genders (cis, trans, agender, genderfluid, and more) and sexualities (hetero, bi, pan, queer, etc.) selected via awkward Mr. Mackey sessions that trigger parent phone calls and retcon jokes; these options exist purely for comedic effect and have minimal gameplay impact beyond occasional dialogue. A major side quest centers on collecting dozens of yaoi artworks of the established gay couple Tweek and Craig, plus helping them with couples therapy, but this directly extends the show's own satirical treatment of the pairing rather than serving as earnest representation.

The infamous skin-tone "difficulty" slider explicitly satirizes claims of systemic racism by making darker characters face harsher social treatment and lower rewards, with Cartman narrating the joke. No DEI consultancies, activist developer statements, or forced source-material changes appear; the premise remains a superhero parody of the boys' antics. Reception shows no meaningful critic-audience gap or "go woke" backlash, consistent with the game's equal-opportunity offense.