Young female athletes in Washington schools would likely have to obtain genital exams to participate in school sports, if a controversial ballot initiative passes in November.
The initiative would ensure that “students compete in athletic activities consistent with the gender assigned at birth,” echoing restrictions in 27 other states and effectively blocking transgender girls from joining girls’ middle- and high-school teams.
Language in the initiative claims that kids are already required to undergo verification of their “biological sex” before they can play sports. But KNKX spoke with medical professionals and a school sports official who said otherwise. Paperwork used by medical professionals in sports physicals also shows that the initiative would be a departure from current state requirements for athletic participation.
According to the initiative, girls would have several options to confirm their sex: a visual genital exam, a lab test to determine their genetic makeup, or an analysis of testosterone levels in the blood. The genital exam, which a medical professional can conduct without touching the child, would likely be the most accessible option for most kids.
But it’s unclear who would conduct the exams, when they should take place, or how to enforce the policy.
Conservative hedge fund manager Brian Heywood and his political action committee Let’s Go Washington are backing the measure. Heywood said he’s concerned with fairness and safety in girls’ sports, insisting that transgender girls have physical advantages over cisgender girls.
“It's at the expense of female athletes and their safety,” Heywood said. “This is not OK. Boys are welcome to play in whatever sport they want within the confines of their biological teams.”
Heywood said he didn’t believe his initiative would add anything new to existing medical requirements for student athletes, a position he also stated to KUOW in September 2025, shortly after launching the measure.
In fact, the measure would be a major shift in the way the state has handled school sports participation for nearly 20 years.
State policy has let kids play on teams that align with their gender identity since 2007. Sports participation does not require students to have a doctor sign off on their birth sex to play a sport, said Justin Kesterson, assistant executive director of the Washington Interscholastic Activities Association, which oversees middle and high school sports.
Student athletes must complete a brief physical examination before playing on a team, but this checkup focuses on things like heart health, vision, and breathing. The state-recommended evaluation forms for doctors to use when assessing student athletes do not include verification of sex. Similar forms used by Seattle Public Schools, the largest district in the state, don’t require a provider to confirm sex either.
The WIAA is aware of roughly 10 trans athletes out of more than 200,000 kids compete across the state, Kesterson said. There may be more trans athletes, however, since the association does not require schools to disclose that information.
Kesterson couldn’t say how new requirements for sex verification would be enforced, were the initiative to pass.
“ There will have to be broader conversations with other entities to provide that guidance,” Kesterson said. “There's going to have to be conversations with the medical professionals across the state as to what is going to be required and what that looks like.”
Dr. Erica Li, a pediatrician who supports Heywood’s measure to block trans girls from girls’ teams, acknowledged that sports physicals don’t currently require sex verification.
But she noted that other types of exams do, such as annual pediatrician checkups, which are more robust than a sports signoff.
Every child who sees a pediatrician regularly should receive a brief genital exam at some point “to confirm that puberty is progressing properly,” Li said. Doctors could use this information to confirm birth sex without conducting a separate visual inspection for the sports physical, she said.
Li said that students could get the genetic or hormone test options listed in the initiative, in lieu of a genital exam. She also said a doctor could review a student’s birth records, though language in the initiative does not mention that alternative.
Other physicians disagree that sex confirmation would be so simple.
Dr. Grace Shih, a family medicine doctor who opposes Heywood’s measure, said sports-readiness exams are different from annual checkups where a genital exam might occur, and that people often confuse the two. She said she wouldn’t feel comfortable using information from a kid’s annual appointments to satisfy a new section on a sports form. This would be a shift in how her practice conducts sports physicals, she said.
Shih supports the No Hate in Washington State campaign that’s working against Heywood’s effort.
She also had concerns about financial and logistical barriers preventing some students from obtaining sex verification.
“There are lots of girls that do not have regular doctors, lots of people with poor access to care, especially in rural areas,” Shih said.
Other opponents of the initiative were concerned about the logistics of conducting sex confirmation.
Former school nurse Katie Johnson, who also supports the No Hate in Washington State campaign, said schools with large populations of students who don’t have regular access to doctors typically complete the sports physicals in “batches,” so a volunteer doctor may come in for a day and examine students in a large gym or public setting.
“ Students don't take their clothes off. They're fully clothed,” she said.
She was dubious that any school would want to assume the liability of verifying biological sex.
The Washington Chapter of the American Academy of Pediatrics did not respond to a request for comment on this story. Representatives from the University of Washington School of Medicine, Seattle Children’s Hospital, Providence Swedish and Multicare/Mary Bridge Children’s Hospital all declined to comment.
