Personaly, I am impresed with the number of trans people in the game that have acces to surgery or HRT considering the setting is distopian and a crumblig civilisation. In that context any medical intervention that would need monitoring and constent intervention look like a big life threatening choice or a ruinuous one at the verry least. Blake not having implants or hormones, in my mind, is more fitting. That on the other hand does not mean that he couldn't wish for it while balancing the pros and cons in his head. History is full of small example of trans persons before any medical interventions where even dreamed of being a possibility. (admitedly sometime you have to read a bit between the lines.)
An other example of a fiction work with a trans person not having acces to medical transitioning tools is the franco belgium commic book Baraccuda by Jean Dufaux and Jérémy petiqueux. A pirate story centerd in the Caraïbes. The only tool the character has acces to is a corset. here is a link th the wikipedia page :
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the page is in french and sadly does not have an english version for people interested to learn more in Shakespear's thoung.