So, the big question you're asking here is one of audience. And you've put yourself in a bit of a pickle, here.
While trans issues hold a pretty substantial bit of the public discussion these days, the specifics are still fuzzy, especially for, say, folks who are so white that Stuart Semple and Anish Kapoor would get in a feud about it. To kill this joke deader, Pusha T - a "coke rapper" most prominent in the early-mid 00's who - is likely to be even less known to your audience.
(As a tangent, I am now imagining "Pusha E," a rapper whose every other bar is about snorting estradiol.)
So then the question becomes, "Who is the target audience here?"
"Queer" is obvious. To be honest, you're likely not far off with your age group, but maybe just a little bit younger - find that hazy line between Gens X and Y.
(The hazard here is that the closer you get to "late-30's/early-40's Black trans dude," the more likely you are to find that they've already heard or made this joke already.)
As for the quality of the joke itself:
It's solid! I'd replace "HRT" with "hormones," though, if only because "T" is a loud syllable and having "Pusha T" and "HR T" only a couple of words apart is gonna hit the eardrums and the brain a little weird. Other than that, excellent, this joke's perfect as-is.