This flag that Air Shakur has on her hat is one of the butch lesbian flags. Additionally, Fine Motion being intersex in this image is most likely inspired by the IRL horse being an intersex mare herself.
They do not specify what type of intersexuality in the article linked, only that it is the cause of her being unable to bear young. (Some fans have speculated the horse to have Swyer syndrome, but it is moreso a guess based on the limited information given.)
All things considered I'm surprised Fine doesn't have more pride art like this, not complaining to clear btw. Realistically the double ear accessories is just a reference to the Irl horses alleged intersex status and she's a proper female like all Umamusume. Of course you can always have your own head canon, kinda of point of the game, no? (Male or female trainer x uma, Uma x uma).
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