My dude, I write more tag than post sometimes, far be it from me to shame you for reading my tags.

And yes, you are correct!  Alleirat isn’t very developed technologically speaking–they have gravity-driven indoor plumbing, but only a basic system, and clockwork (like…clocks for example, I guess), but it would just never occur to them to do something like build an internal combustion engine because they have magic to perform the same job.  Horses (as well as most other fauna) is stronger, more resilient, and longer-lived (also often bigger) due to the high concentration of magic in the world, so short-distance travel is easily accomplished either on foot or on horseback.  For long-distance travel (Alleirat as a continent is maybe a little smaller than Russia?), they have what they call kathen, or ‘gates’ (like a magic door, basically), which are controlled and manipulated by teams of specifically trained magic workers who literally cannot do other types of magic.  Kathen can’t transport large amounts of cargo because the opening can rarely be made larger than maybe a set of double doors, so shipments are often accomplished by sailing ships or overland caravans.

Medically speaking, again, they’re heavily reliant on magic.  A specific kind of magic worker called a flesh worker serves as a universal healer, but that does mean that there are some logistical limitations in comparison to our own medically advanced society.  A flesh worker can repair the damage from a sword wound to the chest or even kill a cancer with a thought, yeah, but the idea of an organ transplant, a limb reattachment, or even a blood transfusion just wouldn’t occur to them.  So a flesh worker (re: the HRT thing) might be able to increase one hormone or decrease another, but it would be a wicked precarious arrangement far less manageable than our medically accomplished version.  Likewise, a flesh worker might be able to perform the equivalent of top surgery (or, if you went to one of the less legal flesh workers, actually alter the bone structure of your face) but…there are a lot of limitations there.  Moreover, they don’t have the equipment to even start to approach some of this stuff–like, a flesh worker does all their healing with their bare hands, they don’t exactly keep sterile needles around for blood transfusion.

…I’ve put a reasonable amount of thought into this.