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Transgender Policy, Part 2: Washington Would Make Girls Prove Their Sex to Play Sports — Is America Better Yet?

Washington’s IL26-638 would require girls in covered school sports to obtain medical proof of biological sex. The AAP says sex verification is not part of sports clearance; APA opposes exclusionary bans.

Roberto Zapatero

— 8 min read
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Part 2 of IABY’s examination of transgender policy asks a different version of the same question: when an ordinary standard already exists, what justifies adding a separate identity-based test?

By Roberto Zapatero
Independent Forensic Investigative Journalist, Is America Better Yet?
Published: August 30, 2026
Living Record: current through August 30, 2026

Every girl who wants to compete in a covered female-only interscholastic sport in Washington would face a new requirement if Initiative IL26-638 passes in November.

She would have to provide a statement signed by her personal health care provider verifying her “biological sex.” The initiative says the provider may rely only on one or more of three things: reproductive anatomy, genetic makeup, or normally produced testosterone levels.

The initiative does not say every girl must undergo a genital examination. But it does create a new government-required sex-verification step that Washington’s recommended sports-physical forms do not now contain.

That distinction is the heart of this story.

The argument is not only about transgender girls. It is also about what the government would require from every girl seeking access to a covered female-only school sport.

Part 2 of the same question

Part 1 of this series examined the Trump administration’s transgender military policy and asked whether proven performance, readiness and compliance with military standards should control when a service member can already do the job.

This second story moves from the military to school sports.

The setting is different. So are the governing laws.

But the accountability question is similar:

When an existing system already measures whether a person is qualified to participate, what evidence supports adding a separate identity-based requirement?

For Washington student-athletes, the existing sports physical is designed to determine medical eligibility and identify health risks.

IL26-638 would add something else: verification of biological sex for students seeking to compete in covered female-only sports.

What the current sports physical actually asks

The Washington Interscholastic Activities Association links to a recommended preparticipation physical-examination form developed by major medical and sports organizations, including the American Academy of Pediatrics and American Academy of Family Physicians.

The form checks matters such as blood pressure, vision, heart, lungs, abdomen, neurological health and the musculoskeletal system.

It contains no field asking a clinician to verify a female athlete’s biological sex.

The companion medical-eligibility form, the document intended to go to the school or sports organization, asks whether the athlete is medically eligible to participate. It does not ask the provider to report reproductive anatomy, chromosomes or testosterone levels.

The WIAA form also states that the detailed physical-examination form should remain in the athlete’s medical file and that only the medical-eligibility form should be submitted to the school or sports organization.

That means the proposed initiative would not merely continue the existing clearance system. It would add a separate verification requirement for girls seeking covered female-only sports.

The AAP describes the purpose of the preparticipation physical evaluation as helping determine whether young athletes can participate safely and identifying health conditions that may need further evaluation.

AAP sports-medicine material also says transgender athletes can be evaluated for medical eligibility through the standard preparticipation physical-evaluation process.

The American Academy of Family Physicians has stated in its published sports-evaluation guidance that a routine genital examination is not recommended for female athletes.

None of that means reproductive anatomy can never be medically relevant during a child’s health care.

It means something narrower: ordinary sports clearance and government-required sex verification are not the same medical task.

The genital-exam issue is real, but it is not the whole story

IL26-638 permits biological sex to be verified by relying on reproductive anatomy, genetic makeup or normal endogenous testosterone levels.

The initiative does not specify exactly how a provider must establish those facts.

Supporters say clinicians would have discretion and have pointed to alternatives such as genetic testing through a cheek swab. Opponents argue that genetic or hormone testing may be costly or impractical and that relying on reproductive anatomy could lead to genital examinations.

Both points belong in the record.

What the initiative itself establishes is that a provider must verify biological sex and must base that verification on one or more of those three categories. It does not expressly mandate a genital inspection of every girl.

That is why reducing the entire controversy to the phrase “genital exams” misses the larger policy change.

The government would be creating a sex-verification condition for participation.

The pediatricians objected to how their guidance was being used

The dispute became sharper when supporters prepared their argument for Washington’s pending voters’ guide.

The proposed “Argument for” language says students would compete in the category matching their sex, verified during routine, medically necessary primary care recommended by the American Academy of Pediatrics. It then describes verification based on birth records, medical history or a standard, noninvasive physical examination.

The Washington chapter of the AAP objected.

In an email thread published by health journalist Benjamin Ryan, and which Ryan reported was supplied by Let’s Go Washington, Washington AAP executive director Dr. Lelach Rave said the organization had not been consulted and that the wording did not accurately portray AAP guidance on pre-sports examinations.

Rave asked that the AAP reference be removed.

She also drew an important distinction. Routine well-child care may include examination of genital development in some children. But, she said, AAP guidance does not say that verifying sex is needed for medical clearance to participate safely in sports.

AAP general counsel later told the initiative’s supporters that readers could reasonably interpret the disputed wording as AAP support for sex verification in that setting and again asked that the organization’s name be removed.

Let’s Go Washington declined to remove it.

The campaign’s executive director, Darren Littell, publicly defended the language. He said the statement does not claim that the AAP endorsed the initiative and argued that it accurately describes AAP well-child guidance.

That response matters because there is a factual kernel behind the campaign’s defense: pediatric well-child examinations can include assessment of genital development in some ages and circumstances.

But that does not resolve the dispute.

The AAP’s objection is about context. A routine pediatric examination is not the same thing as requiring a clinician to certify biological sex as a condition of athletic eligibility.

That is the distinction voters need to see.

The AAP’s concern is not isolated

The AAP has previously opposed laws excluding transgender students from teams consistent with their gender identity.

In the litigation over Idaho’s sports law, the AAP joined other medical organizations in an amicus brief supporting the challenge. AAP reporting at the time described state measures barring transgender youth from sports consistent with their gender identity as discriminatory and potentially harmful.

That history does not make the AAP the final authority on the law.

It does show that citing AAP medical guidance in support of a sex-verification system can reasonably create confusion about whether the organization supports the policy itself.

The American Psychological Association goes further

The American Psychological Association maintains a current resource opposing exclusionary transgender sports policies.

APA says transgender students should have equal opportunity to participate in education and athletics and has argued that exclusion from sports consistent with gender identity can contribute to stigma and harm.

APA also filed an amicus brief in the Supreme Court litigation over Idaho and West Virginia sports restrictions.

Again, that is a professional organization’s position. It is not law.

And the Supreme Court did not adopt it.

But it is relevant evidence when policymakers invoke health, safety or child welfare to justify a rule affecting young people.

The medical and psychological organizations most directly involved in child health and mental health have not treated transgender exclusion or sex verification as an ordinary extension of a sports physical.

What the Supreme Court actually decided

On June 30, 2026, the U.S. Supreme Court decided West Virginia v. B.P.J. together with Little v. Hecox.

The Court held that states may maintain women’s and girls’ sports for biological females and may determine eligibility for those teams based on biological sex. It rejected the Title IX and equal-protection challenges before it.

That ruling is significant and must be stated plainly.

Supporters of IL26-638 now have strong Supreme Court authority for the proposition that a state may use biological sex when setting eligibility for girls’ sports.

But the Court also identified limits to what it was deciding.

The ruling did not hold that states must exclude transgender girls. It did not decide whether schools may voluntarily allow them to participate. And it did not decide whether reproductive-anatomy checks, genetic testing or hormone measurements are necessary or appropriate ways to verify eligibility.

Those are separate policy questions.

Legal authority to use biological sex as an eligibility category is not the same as medical evidence that a particular verification system is necessary.

What Washington voters are actually deciding

The certified initiative is on Washington’s November 3 ballot.

Its supporters say the measure protects fairness, safety and competitive balance in girls’ sports. The Supreme Court has recognized fairness and safety as important governmental interests in allowing states to maintain sex-based athletic categories.

Opponents say IL26-638 goes further than defining those categories because it requires girls seeking covered female-only sports to obtain medical verification of biological sex.

Both can be true at the same time.

A state may have legal authority to separate sports by biological sex and still face a separate question about how much proof it should demand from children to enforce that line.

That is the issue underneath the slogans.

Not whether doctors ever examine genital development.

Not whether biological differences can matter in athletics.

Not whether the Supreme Court permits states to organize girls’ teams by biological sex. It does.

The unresolved policy question is narrower and more concrete:

What should a girl have to prove about her body before the government lets her onto the field?

Watch IABY for updates. Subscribe free to get new reporting by email.

Sources

Verification and method note

IABY reviewed the initiative text, Washington election records, WIAA-linked medical forms, AAP and AAFP sports-physical guidance, APA materials, the Supreme Court decision, the campaign’s public response and reporting containing the AAP correspondence.

The Washington Secretary of State currently says the online voters’ guide will be available by mid-September and the printed Voters’ Pamphlet will be delivered in early October. As of August 30, the Secretary of State’s public ballot-measure page does not yet display the “Argument for” and “Argument against” materials. IABY therefore describes the disputed language as a pending or draft voters’ guide argument and does not report that the printed pamphlet has already been mailed statewide.

Artificial intelligence was used to assist with research organization, drafting, editing and verification. AI-generated material was not treated as evidence. Factual claims were checked against identifiable sources before publication.

Roberto Zapatero (IABY) remains responsible for the reporting, writing, sourcing, editorial judgment and final published text. AI assistance does not replace source records, human review, principal article writing or independent verification.

Copyright: © 2026 Roberto Zapatero / Is America Better Yet? All rights reserved.

If you have firsthand experience with school sports physicals, transgender-athlete policies or IL26-638, IABY welcomes documented information and corrections. Please protect minors’ privacy and do not post children’s medical information publicly.

Thanks to the people who help IABY with research, fact-checking, sourcing and technical work.

I write for you,

— Roberto

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