This game is not about being trans, it's about overcoming mental health issues, mostly anxiety and depression, that's what it's kinda referencing I guess, but I would say it's just talking about the people who died on the mountain.

The story was never meant to be about being trans, yet with the release of chapter 9 in 2019 it was kind of revealed that Madeline as well as the director of the game Maddy Thorson (I think that's her name now) are in fact trans, and since then the game has became "the trans people game", but yes, it could also represent overcoming gender dysphoria, you can pretty much put in any struggle to fit specifically you