As opposed to gender identity, your question seems to focus on clinical aspects that can impact identifying a sex classification value for use in clinical care. The guide does not intend to cover clinical situations that could result in the need for communicating a sex classification value in the provision of clinical care. Instead in the background section we are focusing on the impact of the use/misuse of sex classification, and misappropriation of gender identity in clinical situations. This background lays a foundation for the value of the proposals in the IG.