The intent was that the gender-identity value set is a minimum set, where each jurisdiction is expected to include identities that are relevant in their community.     We will update the gender-identity value set definition to make that clear: Definition: Codes that indicate a individual's gender identity.  This value set is a minimum set of commonly used values.  It is expected and encouraged that specific jurisdictions or communities will use additional gender identity concepts that are relevant within their community.   We will also submit a separate tracker against the Gender Harmony IG to update the Gender Identity terminology (GI) page to clarify this.