The film features a gay couple whose relationship is normalized and integrated into the story without being central to the plot or themes. Their identity is neither celebrated nor denigrated, serving as an incidental aspect of the characters' lives within the horror narrative.

The film features Jamie Clayton, a trans woman, in the iconic role of Pinhead. While this casting provides significant representation, the character's trans identity is not explicitly explored or central to the narrative. The film's portrayal of Pinhead as a gender-ambiguous entity, without direct engagement with trans themes, results in a neutral impact regarding transsexual characters and themes.

The iconic Cenobite leader, Pinhead, a character canonically established as male in the original novella and prior film adaptations, is portrayed as female in the 2022 film. This constitutes a gender swap for a central legacy character.