The core concept here is buying the game from the UK marketplace, allowing you to unlock the free nudity dlc as a download.
Payment
This is the primary hurdle, once you can solve this the rest is easy.
Problems I had
I couldn’t enter my US credit card for payment because the postal code is in a different format.
I tried using PayPal and I believe a similar problem was preventing PayPal clearing the EU store. My Solution
I purchased a digital UK giftcard in Pounds to cover the amount of the purchase with room for taxes.
Find an online retailer you trust, I found a site that sold digital UK xbox giftcards.
This is tricky, there are phishing/scam sites who want your information so I will make no recommendations as this is an AT YOUR OWN RISK transaction. I recommend you find a site who will transact with PayPal as this is more secure.
Make sure you buy a gift card that can cover the entire transaction, tax, ect.
there are other methods you may devise to make this transaction the above was my solution
The above link is the digital store for the UK marketplace Conan Exiles, the bundles include the free nudity DLC, the only way I found to own this free DLC was the purchase the full title.
I used the website over changing my location on the xbox itself.
Use the 3 horizontal dots to the right of the blue purchase button to redeem your gift code, then purchase as normal.
Download the DLC
Your Xbox may already have started the download if you have auto-download set on your xbox. Otherwise go to your game check under “ready to install” and download the DLC.
Start up your game and you are good to go, ensure your settings are now correct and enjoy feeling like an American again.
I found it really frustrating that non-US consoles have it and US doesn’t. If just PC had it I think I wouldn’t have blinked an eye. I know games like GTA have been banned in other countries and overly bloody games may have a toned-down version released overseas or not at all. But for the US to experience the equivalent of media censorship exclusively really doesn’t sit well with me regardless of content and medium
You don’t have to buy the game from the UK store, just set your console country to UK. It allows you to download the free nudity DLC. As long as the server you are on has it enabled then you can have nudity.
For some people I have read that what @CynnaMonkey is saying works, for some reason I couldn’t get the DLC to download even tho I had the game so I went this route, this appears to be a marketplace issue I had seen other users from the UK report. I believe its because they don’t just want people to switch and grab the DLC?
But I am not sure MS is willing to work with me if I called in and tried to explain, I am also not sure I want to explain myself to an adult on the phone over this issue. “Hi I am from the US and I am trying to do this thing that your probably going to frown upon when try to talk you into helping me download digital private parts for free in “violation” of some rating BS?” If it can work for more people free I hope it does in the future, I don’t believe in censorship I believe in personal curation of media so I would hope people could just access what they paid for or where under the impression they paid for
Correct, this is why I avoided switching my country on the xbox and logged into the store on my browser, to prevent any issues regarding the console. But the DLC is not standalone in the UK store it is only bundled in with the game at the present time. This is probably meant to prevent the console switching that originally happened surrounding this topic
Payment 
Problems I had 
My Solution 
Buy the Game from the Uk store 
Download the DLC 
FREEDOM!
