Its core content centers progressive ideological elements through prominent LGBTQ+ representation that drives major character arcs. Ellie, established as lesbian, has a central same-sex romance with Dina that serves as the emotional core of her story, including intimate scenes and relationship milestones.

Lev, a transgender boy, receives explicit focus with plot elements tied to his identity, including deadnaming. Naughty Dog developers, including Neil Druckmann and Halley Gross, openly stated intent to weave diversity—including lesbians, bisexuals, transgender characters, and varied ethnic backgrounds—into the narrative as essential for richer storytelling and to reflect modern society, prioritizing representation over traditional norms.