Seattle Times: Why you should vote ‘no’ on I-638, banning transgender girls from school sports

We are a few of the more than 100 Washington pediatricians, family doctors and nurses who oppose I-638’s new sex inspection requirements. The initiative is a government mandate forcing us to conduct medically unnecessary and potentially harmful tests on elementary, middle and high school girls. This includes genital exams, and genetic or hormone tests, as a new part of sports physicals.
I-638, officially known as the Defending Equity in Interscholastic Sports Act, is part of a coordinated and thinly veiled political attack on all girls, not just vulnerable transgender children. As The Seattle Times editorial board wrote in their opposition to I-638 : it “would send Washington back to the days of ‘femininity certificates,’ when amateur women athletes, including Olympic athletes, had to carry proof that they had passed visual exams and chromosome testing that proved they were women.”

Under I-638, sponsored by MAGA megadonor Brian Heywood’s Let’s Go Washington, any girl from elementary to high school who wants to play sports would be forced to provide medically verified proof of their sex as a new part of sports physicals just for girls. Boys are exempt. It prohibits parents from using birth certificates, and Section 3(2)) states that, to be in compliance, doctors must subject girls to examinations of their “reproductive organs,” or make parents pay for expensive genetic or hormone testing. Insurance will likely not pay for these expensive genetic and hormone tests because they are not medically necessary to diagnose, treat or manage a specific health condition.

Washington students currently remain fully clothed during sports readiness exams, and exams focus on cardiovascular, musculoskeletal and neurologic systems. But I-638 would change that, potentially even requiring pelvic exams, which are medically unnecessary for sports, and can emotionally and physically harm young girls. The American College of Obstetricians and Gynecologists says there is no medical reason for a pelvic exam for girls younger than 21, unless the patient has other health concerns.

The initiative is so poorly written that its sponsors have even said they wish they had written an initiative with more clarity on how it would be implemented. There is no explanation of when and how the government will enforce these rules, who can conduct sex inspections or what evidence will be required during genital, hormone or genetic tests. It could be used to demand that girls as young as kindergarten or girls who participate in nonathletic activities like e-sports prove their sex to a stranger. I-638 is clear about only one thing: The government gets to make personal decisions for our patients and their parents.

Nearly 150,000 school-age girls across Washington state do not have a regular doctor — this is especially true for low-income, rural and immigrant girls, and girls of color — and would be subject to genital examinations by strangers. The American Academy of Family Physicians says sports physicals should take place “not in a group setting,” but many families depend on free large group sports physicalswhere girls could face greater embarrassment and trauma from invasive genital inspections.

By requiring girls to undergo invasive inspections, I-638 would decrease participation, robbing girls of the physical, social and emotional benefits that sports provide. More than half of teenagers experience anxiety or depression. In the midst of a youth mental health crisis, the last thing we should do is put up barriers to healthy and social activities.
I-638 would force us to violate an ethical code to do no harm to our patients. That’s why we are joining the WA State PTA, WA State Nurses Association, Planned Parenthood Alliance Advocates, the League of Women Voters, and thousands of parents and teachers across the state in urging voters to vote No on I-638.

Grace Shih: MD, is a physician, reproductive health specialist and professor in the Department of Family Medicine, University of Washington.
Glenna Martin: MD, MPH is a family physician in Seattle. She sits on the board of Pro Choice Washington.
Caitlin Blau: DO, is a family physician in Bellingham.
Sam Doyle: ARNP, is a nurse practitioner at Fred Hutchinson Cancer Center and a UW teaching associate of Medicine and Pulmonary, Critical Care and Sleep Medicine.