The reference to LOINC is only for the concept of "Gender Identity", not for the value set or any of its members. The wording will be changed to:   There are two different terminologies that are relevant for gender identity.  The LOINC code  76691-5  identities the Gender Identity concept itself, while a value set using SNOMED codes can be used to represent the gender identities. The Gender Identity terminology in this guide is intended to be a minimum value set.  Different jurisdictions are expected and encouraged to adopt their own gender identity codes that represent the identities of their communities.  For example, in the United States, two-spirit may be included in the value set, while in South Asia, hijra may be included. Gender Identity minimum value set  is built using concepts from the  SNOMED CT International edition  code system.  In addition the value set includes the HL7 null flavor UNK to be used if the gender is not known, as well as the asked-declined code from Data Absent Reason to represent case where an individual does not wish to provide their gender identity. Please note that CDA requires the use of value sets that do not include null flavor concepts, therefore the CDA entry templates bind to a separate “core” value set of SNOMED CT concepts, and that value set is used to build the overall gender identity minimum value set.   see minutes from: https://confluence.hl7.org/display/VOC/2023-03-02+GI-SPCU+Subgroup+Meeting+Agenda+and+Notes