Let me see if I understand this correctly. We are trying to accurately reflect both “sex” and “gender” in the CDM, with these considerations:
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There are three categories of sex, a congenital characteristic assessed by the appearance of genitalia/reproductive organs: Female, Male, and Intersex.
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A person identified at birth as “male” or “female” at birth might subsequently be reclassified as “intersex” based on clinical observations. No other transitions of “sex” exist, barring clerical or observational errors at delivery.
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Gender, is a construct of perception of personal characteristics, both physical and non-physical which is influenced by genetic characteristics and social norms.
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There are presently many gender terms in use, and it appears likely that the list will continue to grow/evolve.
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At any time a person might identify with more than one gender or revise their characteristic.
If so, it seems that Gender needs to be a time-stamped record in the Observation table, hopefully standardized to a vocabulary curated by another entity.