Krem is the second openly transgender character in the Dragon Age series, the first being Maevaris Tilani from the comic mini-series Dragon Age: Those Who Speak. Patrick Weekes went into detail about the multi-year creation process for Krem in a blog post published on the official BioWare blog dated December 4, 2014. They revealed that the idea for Krem first began when BioWare organised a panel discussion on how characters from the LGBTQ community are presented in its video games at a prior PAX event. Weekes claimed that an oft-repeated request from fans was for a respectful representation of transgender and/or genderqueer characters, without resorting to stereotypes or tokenism.
The writing team for Inquisition brainstormed and eventually came up with an idea to make the Iron Bull's lieutenant as such a character. Weekes developed the idea that Iron Bull's character, as a mercenary commander, would require the presence of a subordinate as a grounding force "to remind players that Bull has a history of command" and that he "is more than just hired muscle". This character would represent Iron Bull's dilemma over being pulled between a life of freedom and a life of devotion and submission to the Qunari system of thought and behavior, the Qun, and that his status as a trans man could enable them to explore gender roles in Qunari culture. Weekes noted that their writing goal was for Krem "to be a positive character who was living his life happily now", noting that a team of editors would examine every line of dialogue involving Krem and alter any dialogue and paraphrases that may give a wrong impression. Iron Bull and Krem would constantly bicker about little things as part of their relationship dynamic, but never attack each other's "truly sore spots".
The lead writer of Inquisition, David Gaider, recalled that he approved of Weekes' proposal to portray the Iron Bull's lieutenant as a trans man during a meeting, and he suggested canvassing feedback from someone within the transgender community. Gaider explained that Serendipity, a minor queer character who appeared in the Dragon Age II downloadable content Mark Of The Assassin, was intended to be a drag queen, but her comedic portrayal was interpreted by some fans as transphobic. He found the criticisms directed towards Serendipity to be regrettable, and he wanted a transgender character to be properly depicted should the opportunity present itself.
Weekes disclosed that they had received criticism after soliciting constructive feedback about their characterization of Krem from their friends within the genderqueer community; an initial draft which had Krem deserting from the Tevinter Imperium after fighting off someone who discovered his secret and attempted to assault him was derided for relying on the "attacked trans person" stereotype. The feedback Weekes received indicated that while the scenario is plausible, it may inadvertently become an emotional trigger for real life transgender players who have faced traumatic transphobic attacks.