The current content will lead to confusion regarding the new birthsex and the esxisting patient.gender elements. Both use basically the birth sex identifier (with the exception of asked but unknown which is absent for patient.gender). However, patient.genderIdentity is specific to actual gender. The continued use of the Patient.gender and the new Patient.genderIdentity will be confusing as will how an implementer is expected to use patient.birthsex when it basically addresses the existing patient.gender which is misleading.