Five-second answer

Claim we investigated

Initiative 638 will require genital examinations for female athletes.

False. The text lets providers verify sex by genetic testing or testosterone levels instead; no genital exam is mandated. The initiative's filed text and the Attorney General's explanatory statement both list three alternative verification bases, any one of which suffices, so the measure contains no genital-examination mandate.

Quote or cite this fact-check

FactHub rates the claim “Initiative 638 will require genital examinations for female athletes” False (high confidence): The text lets providers verify sex by genetic testing or testosterone levels instead; no genital exam is mandated. Reviewed October 27, 2026. https://facthub.org/n/article/wa-i638-genital-exam-claim/9

One-minute summary

What the evidence establishes

  • Established. Section 3(2) of the initiative requires a provider-signed statement verifying biological sex for students entering female-only competition.
  • Established. The provider may rely on one or more of three bases: reproductive anatomy, genetic makeup, or normal endogenously produced testosterone levels. Any one suffices, so no genital examination is required.
  • Established. For most girls, verification can be a signature: AAP guidelines call for checking genital development at well-child visits from age 7, so a regular doctor usually already has a record of her anatomy, and the text does not bar relying on it.
  • Established. The Attorney General's explanatory statement in the voters' pamphlet describes the same three bases and says students would need some type of medical evaluation.
  • Established. Today's standard sports-physical exam form has no genital item, so any verification would be a new step. The family-completed history form does ask sex assigned at birth.
  • Not shown. Reporters and opponents say an anatomy check may be the most accessible route for many families, because genetic and hormone tests may cost more; how it would work in practice is still undetermined.
  • Established. The No argument cites the wrong section (Section 2, not 3(2)) and misquotes the text as 'reproductive organs'; the text says 'reproductive anatomy'.
  • Established. Washington's sanctioned interschool sports run from grade 7, or grade 6 where a district opts in; the text itself sets no grade floor.
  • Context. KUOW's June 4, 2026 story, the most-cited source for the exam claim, said the initiative's options included 'a visual genital exam', a phrase the text does not use.
Important context: Initiative IL26-638 is on Washington's November 3, 2026 ballot. It would bar students it defines as biologically male from female-only interscholastic competition and require every student entering those activities to submit a statement from the student's personal health care provider verifying biological sex. The No campaign's voters' pamphlet argument is headed 'Doctors and Nurses Warn It Requires Invasive Genital Exams On Girls.' This check addresses whether the measure requires a genital inspection, and rates three related sentences from the No argument; it does not judge whether the policy is wise, fair, or lawful. FactHub takes no position on I-638.

Vote No Because Doctors and Nurses Warn It Requires Invasive Genital Exams On Girls

Committee for the argument against Initiative IL26-638 (Justin Gill, APRN, and five co-authors), Authors of the official voters' pamphlet argument against IL26-638 2026 Washington voters' pamphlet, Initiative Measure IL26-638, p. 22, argument against: "Vote No Because Doctors and Nurses Warn It Requires Invasive Genital Exams On Girls" · · Assertion

Context: A heading of the No argument on what verification would involve.

Source: Washington Secretary of State, 2026 General Election voters' pamphlet (statewide edition) · View in the dataset

The evidence

The conclusion rests on the combined record. Expand each item to see its role and limitations.

Independence note: This check uses 8 methods across 10 institutions and 1 country or international grouping.
Evidence map
Method Institution / country Year(s) What it shows Key limitation Primary links
Primary legal text review Washington Secretary of State United States 2025 Initiative Measure No. IL26-638, filed June 2, 2025, adds a new section to chapter 28A.600 RCW. Section 3(2) requires a student who elects to compete in female-only individual or team activities to provide, as part of the required sports physical, a statement signed by the student's personal health care provider verifying the student's biological sex, relying only on one or more of reproductive anatomy, genetic makeup, or normal endogenously produced testosterone levels. The phrase one or more means any single basis can suffice. The text names no examination procedure and assigns no role to school staff. Section 2 amends the statute on the WIAA's general powers; the verification rule is in Section 3. The text does not define biological sex or personal health care provider, does not say whether prior medical records may be used, and sets no testosterone threshold. Its practical effect depends on implementing rules that have not been written. Washington Secretary of State
Official explanatory statement review Washington Attorney General's Office United States 2026 The Attorney General's explanatory statement in the 2026 voters' pamphlet says the provider's verification would have to be based on reproductive anatomy, genetic makeup, or normal endogenously produced testosterone levels, and that students would have to undergo some type of medical evaluation of their sex. It does not describe a mandated physical inspection. An explanatory statement is a condensed restatement of the text, prepared by the same state government, and is not an independent interpretation of how the requirement would be carried out. Washington Secretary of State
Clinical practice guidance and standard forms review American Academy of Family Physicians, American Academy of Pediatrics, Washington Interscholastic Activities Association United States 2019, 2021, 2026 The 2019 multi-society Preparticipation Physical Evaluation guidance, summarized in American Family Physician in 2021, focuses the sports physical on cardiovascular, musculoskeletal, and neurologic systems. The current American Academy of Pediatrics exam form has no genitourinary item but asks clinicians to check radial and femoral pulses and the abdomen. The family-completed history form asks sex assigned at birth and stays in the medical file. The WIAA told KUOW the checkup focuses on heart health, vision and breathing, and that participation does not now require a doctor's sign-off on birth sex. This shows what current sports physicals contain, not what providers would do under the initiative. Practice varies, and an exam form does not say whether a student stays clothed. National guidance does not address Washington's proposed requirement. American Family Physician American Academy of Pediatrics American Academy of Pediatrics KUOW Public Radio
Review of the American Academy of Pediatrics' Bright Futures Guidelines (4th edition) for the 7-17 year visits, and National Survey of Children's Health estimates for Washington American Academy of Pediatrics, U.S. Health Resources and Services Administration (NSCH) United States 2017, 2023, 2024 Bright Futures, the AAP's standard for well-child visits, lists assessing sexual maturity rating of the breasts and genitalia at the 7-10 year visits and, for girls, a visual inspection of the genitalia at the 11-14 and 15-17 year visits. A provider who has followed the guidelines has therefore already observed a girl's reproductive anatomy, one of the three bases the text allows. In the 2023-24 National Survey of Children's Health, 25.3% of Washington children had no personal doctor or nurse. These are recommendations, not a record of what clinicians do, and practice varies. The text does not say whether earlier findings may be used, and implementing guidance has not been written. About one in four Washington children has no personal doctor or nurse, so many girls have no such record. American Academy of Pediatrics American Academy of Pediatrics Data Resource Center for Child and Adolescent Health (NSCH)
News reporting with interviews of physicians and officials KUOW Public Radio United States 2026 KUOW reported in June 2026 that a visual genital exam, which can be done without touching the child, would likely be the most accessible option for most students. A pediatrician who supports the measure said providers could rely on findings from earlier well-child visits instead of a separate inspection; a family physician who opposes it said she would not use annual-visit findings for a sports form. Reporting reflects interviews with a small number of clinicians and one WIAA official, before any implementing guidance exists. Predictions about which route most families would use are informed judgment, not data. The story's description of the options uses wording the text does not. KUOW Public Radio
Comparison of advocacy interpretations Washington State PTA, The Daily Herald (Everett) opinion page United States 2026 The Washington State PTA, which opposes the measure, argues that because insurers are unlikely to cover genetic or hormone testing, an intimate exam would become the practical price of play for many girls. A pro-initiative column in the Everett Herald argues that a genetic marker or hormone level alone satisfies the text. Both agree the text lists three alternatives; they disagree about which would be used in practice. Both sources are advocacy: the PTA opposes the measure and the Herald column supports it. Neither is a neutral analysis, and their predictions about costs and insurance coverage are not independently documented. Washington State PTA The Daily Herald (Everett)
Athletic association rules review Washington Interscholastic Activities Association United States 2026 The WIAA's 2026-27 handbook limits its program to students in grades 7 to 12, and lets districts include sixth graders in seventh- and eighth-grade programs. Typical ages in those grades are about 11 and up. The No campaign's website says the measure could affect elementary, middle or high school sports, without giving an example of elementary interschool competition. The initiative also reaches any district-run interschool competition with separate girls' events; the sources we reviewed do not show whether any district runs such events for younger children. Washington Interscholastic Activities Association No Hate in WA State
Review of news coverage and campaign materials KUOW Public Radio, No Hate in WA State United States 2026 KUOW's June 4 story told readers that according to the initiative, students' options included a visual genital exam, and that it was unclear who would conduct the exams, though the text names the student's personal health care provider. The No campaign's site says doctors are directed to inspect 'reproductive anatomy', quoting the text's actual term while its pamphlet argument says 'reproductive organs'. This item documents how the claim was stated in two influential sources; FactHub's companion media audit covers the wider sample and its method. KUOW Public Radio No Hate in WA State
1. The filed initiative text lists three alternative verification bases Primary legal text review

Initiative Measure No. IL26-638, filed June 2, 2025, adds a new section to chapter 28A.600 RCW. Section 3(2) requires a student who elects to compete in female-only individual or team activities to provide, as part of the required sports physical, a statement signed by the student's personal health care provider verifying the student's biological sex, relying only on one or more of reproductive anatomy, genetic makeup, or normal endogenously produced testosterone levels. The phrase one or more means any single basis can suffice. The text names no examination procedure and assigns no role to school staff. Section 2 amends the statute on the WIAA's general powers; the verification rule is in Section 3.

Limit: The text does not define biological sex or personal health care provider, does not say whether prior medical records may be used, and sets no testosterone threshold. Its practical effect depends on implementing rules that have not been written.

Verify: Initiative Measure No. IL26-638, final filed text (filed June 2, 2025)

2. The Attorney General's explanatory statement describes the same alternatives Official explanatory statement review

The Attorney General's explanatory statement in the 2026 voters' pamphlet says the provider's verification would have to be based on reproductive anatomy, genetic makeup, or normal endogenously produced testosterone levels, and that students would have to undergo some type of medical evaluation of their sex. It does not describe a mandated physical inspection.

Limit: An explanatory statement is a condensed restatement of the text, prepared by the same state government, and is not an independent interpretation of how the requirement would be carried out.

Verify: 2026 General Election voters' pamphlet (statewide edition), Initiative Measure IL26-638, Explanatory Statement by the Office of the Attorney General, p. 21

3. Standard sports physicals include no genital exam Clinical practice guidance and standard forms review

The 2019 multi-society Preparticipation Physical Evaluation guidance, summarized in American Family Physician in 2021, focuses the sports physical on cardiovascular, musculoskeletal, and neurologic systems. The current American Academy of Pediatrics exam form has no genitourinary item but asks clinicians to check radial and femoral pulses and the abdomen. The family-completed history form asks sex assigned at birth and stays in the medical file. The WIAA told KUOW the checkup focuses on heart health, vision and breathing, and that participation does not now require a doctor's sign-off on birth sex.

Limit: This shows what current sports physicals contain, not what providers would do under the initiative. Practice varies, and an exam form does not say whether a student stays clothed. National guidance does not address Washington's proposed requirement.

Verify: The Preparticipation Physical Evaluation (MacDonald, Schaefer, Stumph; Am Fam Physician 2021;103(9):539-546) Preparticipation Evaluation: Physical Examination Form (PPE 5th edition, revised) Preparticipation Evaluation: History Form (PPE 5th edition, revised) Transgender ballot initiative could require genital exams for WA secondary school students (Sarah Mizes-Tan, June 4, 2026)

4. Regular checkups already record girls' anatomy Review of the American Academy of Pediatrics' Bright Futures Guidelines (4th edition) for the 7-17 year visits, and National Survey of Children's Health estimates for Washington

Bright Futures, the AAP's standard for well-child visits, lists assessing sexual maturity rating of the breasts and genitalia at the 7-10 year visits and, for girls, a visual inspection of the genitalia at the 11-14 and 15-17 year visits. A provider who has followed the guidelines has therefore already observed a girl's reproductive anatomy, one of the three bases the text allows. In the 2023-24 National Survey of Children's Health, 25.3% of Washington children had no personal doctor or nurse.

Limit: These are recommendations, not a record of what clinicians do, and practice varies. The text does not say whether earlier findings may be used, and implementing guidance has not been written. About one in four Washington children has no personal doctor or nurse, so many girls have no such record.

Verify: Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed.: Middle Childhood Visits (5 through 10 years) Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed.: Adolescence Visits (11 through 21 years) NSCH 2023-24: Medical Home Component: Personal doctor or nurse, Washington

Deeper analysis: Pediatric checkups already document sex, though many Washington girls lack a regular provider. — FactHub rates 'Standard primary pediatric care already verifies sex' Mostly true: regular checkups document anatomy and sex, but a quarter of Washington children lack a personal provider to sign.

5. Reporting finds anatomy may be the most accessible route, with alternatives available News reporting with interviews of physicians and officials

KUOW reported in June 2026 that a visual genital exam, which can be done without touching the child, would likely be the most accessible option for most students. A pediatrician who supports the measure said providers could rely on findings from earlier well-child visits instead of a separate inspection; a family physician who opposes it said she would not use annual-visit findings for a sports form.

Limit: Reporting reflects interviews with a small number of clinicians and one WIAA official, before any implementing guidance exists. Predictions about which route most families would use are informed judgment, not data. The story's description of the options uses wording the text does not.

Verify: Transgender ballot initiative could require genital exams for WA secondary school students (Sarah Mizes-Tan, June 4, 2026)

6. Supporters and opponents read the same text differently Comparison of advocacy interpretations

The Washington State PTA, which opposes the measure, argues that because insurers are unlikely to cover genetic or hormone testing, an intimate exam would become the practical price of play for many girls. A pro-initiative column in the Everett Herald argues that a genetic marker or hormone level alone satisfies the text. Both agree the text lists three alternatives; they disagree about which would be used in practice.

Limit: Both sources are advocacy: the PTA opposes the measure and the Herald column supports it. Neither is a neutral analysis, and their predictions about costs and insurance coverage are not independently documented.

Verify: Washington State PTA Opposes Initiative IL26-638 (August 6, 2026) Welch: 638 does what critics say it can't — protect girls without banning anyone (opinion, August 1, 2026)

7. Sanctioned interschool sports start at grade 7, or 6 Athletic association rules review

The WIAA's 2026-27 handbook limits its program to students in grades 7 to 12, and lets districts include sixth graders in seventh- and eighth-grade programs. Typical ages in those grades are about 11 and up. The No campaign's website says the measure could affect elementary, middle or high school sports, without giving an example of elementary interschool competition.

Limit: The initiative also reaches any district-run interschool competition with separate girls' events; the sources we reviewed do not show whether any district runs such events for younger children.

Verify: WIAA Handbook 2026-27 About I-638

8. Coverage and campaign materials repeated the exam claim Review of news coverage and campaign materials

KUOW's June 4 story told readers that according to the initiative, students' options included a visual genital exam, and that it was unclear who would conduct the exams, though the text names the student's personal health care provider. The No campaign's site says doctors are directed to inspect 'reproductive anatomy', quoting the text's actual term while its pamphlet argument says 'reproductive organs'.

Limit: This item documents how the claim was stated in two influential sources; FactHub's companion media audit covers the wider sample and its method.

Verify: Transgender ballot initiative could require genital exams for WA secondary school students (Sarah Mizes-Tan, June 4, 2026) About I-638

Common questions

“Section 2 says doctors must subject girls to invasive examinations of their "reproductive organs," or expensive genetic or hormone tests.”

Our rating: Misleading

The verification does have to rest on anatomy, genetics or hormones, so the sentence has a real basis. But the rule is in Section 3(2), not Section 2; the text says 'reproductive anatomy', not 'reproductive organs'; and it lists bases a provider may rely on rather than saying doctors 'must subject' girls to anything. A visual check can be done without touching the child, but families may still find it intrusive, and the measure does not require one: a girl's regular doctor usually already has a record of her anatomy from routine checkups, and a provider may instead rely on genetics, or on testosterone after puberty. On cost, FactHub's companion cost check finds the genetic route is priced in the hundreds of dollars or more and is unlikely to be covered by insurance for this purpose, so 'expensive' is fair for the lab tests; neither test is required.

Deeper analysis: Most girls could meet I-638's sex verification rule at a no-cost checkup. — Most girls could meet I-638's sex verification rule at a no-cost checkup; lab-test routes are priced from about $21 to $1,310 and likely uncovered.

“Today, students remain fully clothed during sports physicals.”

Our rating: Misleading

True today, but the measure doesn't require undressing. The standard sports-physical exam form has no genital item, and the WIAA says the checkup focuses on heart health, vision and breathing ('fully clothed' is a retired school nurse's description of group physicals; the form also asks clinicians to check femoral pulses and the abdomen, and practice varies). But the sentence's point, beside the No argument's heading that the measure requires invasive genital exams, is that I-638 would make girls undress. That is not so: a provider may verify sex from genetic makeup or testosterone levels, and the text does not rule out a girl's own provider relying on what they already know from past care, so a girl need not undress at all.

“We all want fairness and safety in sports, but this poorly written measure would require girls as young as 8 to undergo intrusive medical sex certification as a new part of sports physicals.”

Our rating: Misleading

Verification would be a new part of sports physicals, and the text sets no grade floor. But Washington's sanctioned interschool sports run from grade 7, or grade 6 where a district opts in, where students are typically 11 or older, and the sources we reviewed show no girls-only interschool competition for 8-year-olds. 'Intrusive' also assumes an anatomy check, when a provider may rely on genetics or testosterone instead.

“The anatomy route is the only realistic one, so the measure effectively requires a genital exam.”

Short answer: Not required

Cost and insurance may lead some families toward an anatomy-based check, and implementing guidance has not been written. But a likely outcome for some is not a requirement for all. For a girl with a regular doctor, her chart usually already records her anatomy, so verification can be a signature with no new exam. The text also lets a provider rely on genetic makeup instead, or on testosterone levels once puberty has begun. A student who uses any of these routes never needs a genital exam, so the claim that the measure will require one is false.

“Testosterone tests are too inaccurate to verify sex.”

Short answer: Not after puberty

A 2005 review in Clinical Biochemist Reviews, drawing on studies of the assays then in routine use, found that none should be used to measure testosterone in the normal female or children's ranges, where small differences matter for diagnosis. It found some adequate for detecting levels above 3.7 nmol/L in women and children, and put the normal adult male range at about 10 to 34 nmol/L. Its concern was measuring low levels precisely, not telling men from women. Measured by mass spectrometry, adult testosterone shows complete separation between men and women, a 2018 review in Endocrine Reviews finds. The real limit is age: before puberty, boys and girls have the same testosterone levels, so the test cannot verify a younger student's sex. A genetic test has neither limit, and the text sets no testosterone threshold.

“Sports physicals already document sex, so nothing would change.”

Short answer: Self-reported only

The initiative's findings make this assertion. The standard history form, filled in by the family, does ask sex assigned at birth, but the exam form has no sex item and the provider does not verify it, and a WIAA official told KUOW that participation does not currently require a doctor's sign-off on birth sex. Verification would be a new step. (Version 4 said the forms have no sex field; the current history form does.)

“Coaches or school officials would inspect girls.”

Short answer: No

The text places verification with the student's personal health care provider, as part of the sports physical. It assigns no examination role to coaches, school staff, or the WIAA.

“Only girls must be verified.”

Short answer: Yes

Accurate. Section 3(2) applies to students who elect to compete in activities intended for female students only. No comparable requirement applies to boys' or open activities. FactHub rates the No argument's 'boys are exempt' sentence True in its check of the 'most extreme' claim.

“News reports said the initiative itself lists a visual genital exam as an option.”

Short answer: Not in the text

KUOW's June 4 story said so, and it also said it was unclear who would conduct the exams. The text says 'reproductive anatomy', names no exam, and names the student's personal health care provider. The story has carried no correction. FactHub's companion check of Washington news coverage examines how this framing spread.

“Many of Washington's 147,500 girls without a regular family doctor would be subject to genital examinations by total strangers.”

Short answer: Overstated

No genital exam is required, since a provider may rely on genetics or testosterone, and the count covers all girls, not athletes. FactHub rates this sentence Misleading in its check of the Yes claim that pediatric care already verifies sex.

Conclusion

The claim that Initiative 638 will require genital examinations is contradicted by the measure's own text. Section 3(2) requires a provider-signed statement verifying biological sex and says the provider may rely only on one or more of three bases: reproductive anatomy, genetic makeup, or normal endogenously produced testosterone levels. Because any single basis suffices, a student can satisfy the requirement through a genetic test, or a testosterone test once puberty has begun, with no genital examination at all. The Attorney General's explanatory statement in the voters' pamphlet describes the requirement the same way. No provision mandates a genital examination, and none assigns coaches or school staff any role in examining students. Confidence is High because the claim is about what the measure requires, and that question is answered directly by the filed text and confirmed by the state's own explanation. This rating does not depend on predictions about implementation. The broader concern behind the claim deserves a separate answer. For most girls, the practical change is a signature, not an exam. Every girl who plays already needs a sports physical, and the American Academy of Pediatrics' guidelines call for checking genital development at well-child visits from age 7, so a girl's regular doctor usually already has a record of her anatomy. A pediatrician who supports the measure told KUOW that providers could rely on those findings, though the text does not say whether prior records qualify. Verification would still be a new step: today's standard sports-physical exam form has no genital item, and the WIAA says the checkup focuses on heart health, vision and breathing. The open question is the minority of girls whose provider does not already know them; about one in four Washington children has no personal doctor or nurse. For them, KUOW reported that a visual exam would likely be the most accessible route, and the Washington State PTA argues insurers are unlikely to cover genetic or hormone testing. Before puberty a testosterone test cannot verify sex, so for younger students the route that needs no anatomy check is a genetic test. These points bear on a different claim, that some girls may end up choosing or being steered toward an anatomy-based check; that claim is plausible but unproven, and depends on cost, insurance coverage, and implementing guidance that does not yet exist. It does not make the stronger claim, that the measure requires genital examinations, accurate. The No argument's specific wording adds errors of its own. It attributes the rule to Section 2, which amends the WIAA's general powers; the verification rule is Section 3(2). It puts 'reproductive organs' in quotation marks, but the text says 'reproductive anatomy', and it says doctors 'must subject' girls to invasive exams or tests, when the text lists bases a provider may rely on and names no procedure. We rate that sentence Misleading: verification does have to rest on anatomy, genetics or hormones, but the sentence misquotes the text and turns a choice of bases into compelled invasive exams. Its statement that students stay fully clothed during sports physicals today is Misleading: it is true of today's standard exam, which has no genital item, but beside the claim that the measure requires genital exams it implies I-638 would make girls undress, when a provider may rely on genetics, testosterone or, the text permitting, what a girl's own provider already knows. Its 'girls as young as 8' is Misleading: the text sets no grade floor, but Washington's sanctioned interschool sports run from grade 7, or grade 6 where a district opts in, ages about 11 and up. Much of the public discussion repeated the exam claim. KUOW's June 4 story, the most-cited source for it, told readers that according to the initiative the options included a visual genital exam, a term the text does not use. FactHub's companion check of Washington news coverage examines how the claim spread. FactHub rates what was said, not the intent of those who said it.

How we checked

  1. Defined the claim precisely: whether Initiative 638 requires a genital inspection for female athletes, as opposed to permitting one or making one likely.
  2. Read the full filed text of IL26-638 from the Washington Secretary of State, focusing on Sections 2 and 3.
  3. Compared it with the Attorney General's explanatory statement in the 2026 voters' pamphlet, a separate official restatement.
  4. Reviewed national sports-physical guidance (PPE5, via American Family Physician) and the current American Academy of Pediatrics history and exam forms to establish current practice.
  5. Reviewed independent news reporting (KUOW) that interviewed physicians on both sides and the WIAA, and the WIAA handbook for the grades its program covers.
  6. Compared the readings of an opposing organization (Washington State PTA), a supporting opinion column (Everett Herald), and the No campaign's own website.
  7. Rated three sentences of the No campaign's pamphlet argument, quoted from FactHub's dataset of the campaigns' pamphlet statements, and recorded limits for each line of evidence.

Editorial note: Scope: this article rates the claim that Initiative 638 requires genital inspection for female athletes, and, as rated objections, three sentences from the No campaign's voters' pamphlet argument. It does not evaluate the measure's broader merits, its likely legal challenges, or claims about the number of transgender athletes. The initiative's practical effects depend on implementing guidance that does not yet exist; this check will be revisited if the measure passes. Quotations from the initiative are from the public filed text. No external specialist review has been recorded.

Expert-review status

No external specialist review has been recorded.

Funding and conflicts

Funding: No external funding for this piece.

Ownership: Published by the FactHub Research Team.

Conflicts: None known.

Sources

Sources are labeled by kind, with what this fact check takes from each, so readers can check the evidence independently.

  1. Government Washington Secretary of State. Initiative Measure No. IL26-638, final filed text (filed June 2, 2025)

    The measure's full text; Section 3(2) contains the verification requirement and its three permitted bases.

    Reliability: The official filed text posted by the Secretary of State. It is the measure itself; the sponsor wrote it.

    • A student entering female-only competition must provide a statement signed by her own health care provider verifying her sex, as part of the sports physical.

      What the source says
      A student who elects to participate in individual or team competition activities intended for female students only governed under subsection (1) of this section shall provide, as part of the required routine sports physical examination, a health examination and consent form or other statement signed by the student's personal health care provider that verifies the student's biological sex,
      Sec. 3(2)

    • The provider may rely on any one of anatomy, genetic makeup or testosterone, so no single procedure is required.

      What the source says
      relying only on one or more of the following: The student's reproductive anatomy, genetic makeup, or normal endogenously produced testosterone levels.
      Sec. 3(2)

    • Section 2 amends the statute on district and WIAA control of interschool activities; the verification rule is a new section, Section 3.

      What the source says
      NEW SECTION. Sec. 3. A new section is added to chapter 28A.600 RCW to read as follows:
      Sec. 3, heading
  2. Government Washington Secretary of State. 2026 General Election voters' pamphlet (statewide edition), Initiative Measure IL26-638, Explanatory Statement by the Office of the Attorney General, p. 21

    The state's neutral explanation of what the measure would do.

    Reliability: Written by the Attorney General's Office as the state's neutral explanation; it is not a ruling on how the text will be applied.

    • The Attorney General says the provider's verification would have to be based on anatomy, genetics or testosterone.

      What the source says
      That form must be signed by the student's personal health care provider. The verification would have to be based on the student's reproductive anatomy, genetic makeup, or normal endogenously produced testosterone levels.
      p. 21, The Effect of the Proposed Measure if Approved

    • The Attorney General says students would need some type of medical evaluation, without naming a genital exam.

      What the source says
      Students would thus have to undergo some type of medical evaluation of their sex to participate in interschool sports designated for female students only.
      p. 21, The Effect of the Proposed Measure if Approved
  3. Peer-reviewed study American Family Physician. The Preparticipation Physical Evaluation (MacDonald, Schaefer, Stumph; Am Fam Physician 2021;103(9):539-546) Identifier: PMID 33929170

    Summary of the 2019 multi-society PPE5 guideline describing what a standard sports physical covers; independent of Washington and of either campaign.

    Reliability: A clinical review in the journal of the American Academy of Family Physicians, one of the six societies behind the PPE monograph; it predates I-638.

    • National guidance focuses the sports physical on the heart, muscles and bones, and nervous system.

      What the source says
      The PPE should include a structured physical examination that focuses on the cardiovascular, musculoskeletal, and neurologic systems.
      Key recommendations / Physical examination
  4. Academic American Academy of Pediatrics. Preparticipation Evaluation: Physical Examination Form (PPE 5th edition, revised)

    The current standard sports-physical exam form; it lists no genitourinary item.

    Reliability: Published by the American Academy of Pediatrics for the 2019 multi-society PPE monograph.

    • Qualifies: The exam form has no genital item but asks clinicians to check femoral pulses and the abdomen, which bears on 'fully clothed'.

      What the source says
      Pulses (radial and femoral)
      Medical section, Cardiovascular
  5. Academic American Academy of Pediatrics. Preparticipation Evaluation: History Form (PPE 5th edition, revised)

    The family-completed history form for the standard sports physical.

    Reliability: Published by the American Academy of Pediatrics for the 2019 multi-society PPE monograph.

    • Qualifies: The history form, filled in by the family and kept in the medical file, asks sex assigned at birth, so physicals do record a self-reported sex.

      What the source says
      Sex assigned at birth (F, M, or intersex):
      History form, page 1
  6. News report KUOW Public Radio. Transgender ballot initiative could require genital exams for WA secondary school students (Sarah Mizes-Tan, June 4, 2026)

    Interviews with physicians who support and oppose the measure and with the WIAA about how verification would work in practice.

    Reliability: Public radio reporting. Its interviews are useful evidence; its own description of the initiative's options uses wording the text does not contain and has not been corrected.

    • Qualifies: KUOW told readers the initiative's options included a visual genital exam and that it would likely be the most accessible; the text says 'reproductive anatomy' and names no exam.

      What the source says
      According to the initiative, students 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.
      Opening section

    • A pediatrician who supports the measure said doctors could use earlier well-child exam findings instead of a new inspection.

      What the source says
      Doctors could use this information to confirm birth sex without conducting a separate visual inspection for the sports physical, she said.
      Paragraphs quoting Erica Li · Erica Li, pediatrician and co-author of the Yes argument

    • The WIAA says participation does not now require a doctor's sign-off on birth sex, and the checkup focuses on heart health, vision and breathing.

      What the source says
      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.
      Paragraphs quoting Justin Kesterson · Justin Kesterson, assistant executive director, WIAA

    • Qualifies: A retired school nurse who co-signed the No argument said students stay fully clothed in group sports physicals.

      What the source says
      Students don't take their clothes off. They're fully clothed
      Paragraph quoting Katie Johnson · Katie Johnson, retired school nurse and No campaign supporter

    • Qualifies: KUOW said it was unclear who would conduct the exams, though the text names the student's personal health care provider.

      What the source says
      But it’s unclear who would conduct the exams, when they should take place, or how to enforce the policy.
      Middle of story
  7. Advocacy group Washington State PTA. Washington State PTA Opposes Initiative IL26-638 (August 6, 2026)

    The strongest documented version of the argument that an intimate exam would be the practical result for many girls.

    Reliability: Has a stake in this finding. The PTA opposes the measure; its statements about insurance coverage are not sourced to insurers.

    • Qualifies: The PTA argues insurers are unlikely to cover genetic or hormone tests, so many girls would face an anatomy exam in practice.

      What the source says
      Since insurance is unlikely to cover the other two options the initiative offers for gender verification, for many girls the practical result would be an intimate examination that serves no medical purpose and exists only to act as a gate keeper for sports eligibility, potentially beginning in middle school and possibly repeatedly.
      Statement body
  8. News report The Daily Herald (Everett). Welch: 638 does what critics say it can't — protect girls without banning anyone (opinion, August 1, 2026)

    A supporting column that responds directly to the genital-exam claim.

    Reliability: Has a stake in this finding. An opinion column supporting the measure, published on a newspaper's opinion page.

    • A supporting column argues a genetic marker or hormone level alone satisfies the text.

      What the source says
      A genetic marker satisfies it. A hormone level satisfies it. Neither requires the kind of exam the opposition describes.
      Column body
  9. Other Washington Interscholastic Activities Association. WIAA Handbook 2026-27

    The rules governing Washington's sanctioned interschool sports, including which grades may take part.

    Reliability: The WIAA is the nonprofit to which Washington school districts delegate interschool athletics; it would carry out I-638 for its member schools.

    • The WIAA program is limited to students in grades 7 to 12.

      What the source says
      Only students regularly enrolled in schools which are members of the WIAA in grades seven to 12 inclusive may participate in the program of the WIAA
      Appendix, Participation - Limitation Based on Gender

    • Qualifies: Districts may let sixth graders join seventh- and eighth-grade programs.

      What the source says
      Depending upon the action of the school district, sixth graders may participate in any … seventh and eighth grade program except tackle Football.
      Rule 18.18.0
  10. Party to the dispute No Hate in WA State. About I-638

    The No campaign's explanation of its arguments.

    Reliability: Has a stake in this finding. The committee opposing I-638, which wrote the No argument in the voters' pamphlet.

    • Qualifies: The No campaign says the measure could affect elementary, middle or high school sports, without naming an elementary interschool competition.

      What the source says
      I-638 could force invasive genital exams on girls just to participate in elementary, middle or high school sports
      Point 1

    • The No campaign's site uses the text's term 'reproductive anatomy' while its pamphlet argument says 'reproductive organs'.

      What the source says
      I-638 is poorly written and vague, directing doctors to inspect “reproductive anatomy” but doctors say this could require pelvic exams for some children.
      Answer to 'What are doctors looking for'
  11. Academic American Academy of Pediatrics. Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed.: Adolescence Visits (11 through 21 years)

    The AAP's national guidance for well-child visits for adolescents, including what the physical examination should cover.

    Reliability: The AAP's clinical guideline for preventive pediatric care, developed by expert panels. The AAP opposes laws like I-638, but these guidelines predate the measure and do not address sports eligibility.

    • For girls aged 11 to 14 (and again at 15 to 17), the guidelines call for a visual inspection of the genitalia to assess sexual maturity.

      What the source says
      Genitalia … Female … Perform visual inspection for sexual maturity rating.
      11 Through 14 Year Visits, Physical Examination, Genitalia, pp. 740-741
  12. Academic American Academy of Pediatrics. Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed.: Middle Childhood Visits (5 through 10 years)

    The AAP's national guidance for well-child visits for children aged 5 to 10.

    Reliability: The AAP's clinical guideline for preventive pediatric care; it predates the measure and does not address sports eligibility.

    • For children aged 7 to 10, the guidelines list assessing sexual maturity rating of the breasts and genitalia.

      What the source says
      Breasts and genitalia … Assess for sexual maturity rating.
      7 and 8 Year Visits, Physical Examination, p. 682 (repeated for 9 and 10 Year Visits, p. 708)
  13. Government Data Resource Center for Child and Adolescent Health (NSCH). NSCH 2023-24: Medical Home Component: Personal doctor or nurse, Washington

    National Survey of Children's Health estimate of Washington children with and without a personal doctor or nurse, 2023-2024 combined.

    Reliability: The NSCH is funded and directed by the federal Health Resources and Services Administration and fielded by the Census Bureau; this query tool is run by the Child and Adolescent Health Measurement Initiative at Johns Hopkins. The figure covers all children 0-17, not girl athletes.

    • Qualifies: In 2023-24, 25.3% of Washington children (95% CI 22.2-28.8%) had no personal doctor or nurse, so many girls have no regular doctor's record to rely on.

      What the source says
      Does not have a personal doctor or nurse … 25.3
      Indicator 4.12a results table, Washington, 2023-2024
  14. Peer-reviewed study Handelsman DJ, Hirschberg AL, Bermon S. Endocrine Reviews. Circulating Testosterone as the Hormonal Basis of Sex Differences in Athletic Performance (2018) Free copy DOI: 10.1210/er.2018-00020

    Peer-reviewed review of testosterone levels in males and females by age and how they are measured.

    Reliability: Published by the Endocrine Society. One author (Bermon) has worked with World Athletics on eligibility rules; the findings cited here, on prepubertal levels and adult separation by mass spectrometry, are not disputed.

    • Qualifies: Before puberty boys and girls have the same circulating testosterone, so a testosterone test cannot verify a younger student's sex.

      What the source says
      Prior to puberty, there is no sex difference in circulating testosterone concentrations or athletic performance
      Abstract

    • Measured by mass spectrometry, adult men's and women's testosterone levels do not overlap.

      What the source says
      Using LC-MS measurement, circulating testosterone in adults has a strikingly nonoverlapping bimodal distribution with wide and complete separation between men and women.
      Paragraph beginning 'Prior to puberty, levels of circulating testosterone as determined by LC-MS'
  15. Academic Clinical Biochemist Reviews (Australasian Association for Clinical Biochemistry and Laboratory Medicine). Are Routine Testosterone Assays Good Enough? (Sydney S. Sacks; Clin Biochem Rev 2005;26(1):43-45) Identifier: PMID 16278777

    A short review of 2003-2004 studies comparing routine testosterone immunoassays with reference methods.

    Reliability: A review in the journal of the Australasian clinical biochemistry association, summarizing studies of assays then in routine use. It predates I-638 and does not address sex verification.

    • Qualifies: Studies of the routine assays in use around 2004 found them too imprecise to measure testosterone within the normal female or children's ranges.

      What the source says
      The authors conclude that none of the assays, including the RIAs, should be used to measure testosterone in the normal female or paediatric ranges.
      Paragraph on Wang et al.

    • The same review found some routine assays adequate for detecting testosterone above 3.7 nmol/L in women and children.

      What the source says
      The DPC RIA, the Elecsys and Vitros are probably, however, adequate for detecting abnormal elevations in testosterone in women and children (i.e. levels above 3.7 nmol/L) by virtue of their relative lack of bias and lesser differences from the reference results.
      Paragraph on Wang et al.

    • The review gives the normal adult male range as about 10 to 34 nmol/L, far above the female range.

      What the source says
      The original testosterone RIAs used pure testosterone standards, were well validated against reference methodology and consistently had a normal range of about 10 nmol/L-34 nmol/L across methods.
      Paragraph on the Matsumoto and Bremner editorial
  16. FactHub dataset Initiative 638: the campaigns' claims in their own words
    • Vote No Because Doctors and Nurses Warn It Requires Invasive Genital Exams On Girls
      Committee for the argument against Initiative IL26-638 (Justin Gill, APRN, and five co-authors), Authors of the official voters' pamphlet argument against IL26-638, · In the dataset
    • Section 2 says doctors must subject girls to invasive examinations of their "reproductive organs," or expensive genetic or hormone tests.
      Committee for the argument against Initiative IL26-638 (Justin Gill, APRN, and five co-authors), Authors of the official voters' pamphlet argument against IL26-638, · In the dataset
    • Today, students remain fully clothed during sports physicals.
      Committee for the argument against Initiative IL26-638 (Justin Gill, APRN, and five co-authors), Authors of the official voters' pamphlet argument against IL26-638, · In the dataset
    • We all want fairness and safety in sports, but this poorly written measure would require girls as young as 8 to undergo intrusive medical sex certification as a new part of sports physicals.
      Committee for the argument against Initiative IL26-638 (Justin Gill, APRN, and five co-authors), Authors of the official voters' pamphlet argument against IL26-638, · In the dataset

Update history

  1. Version 9. Claim and rating unchanged. Replaced the sentence 'A visual check is not invasive in the medical sense', which understated how families may experience a visual exam. Added that for a girl with a regular doctor, routine checkups under AAP guidelines already record her anatomy, so verification can be a signature (new evidence item, key point and conclusion text), citing the Bright Futures guidelines and NSCH data. Noted that testosterone cannot verify sex before puberty, leaving a genetic test as the non-anatomy route for younger students, and added a common question on testosterone test accuracy citing a 2005 review in Clinical Biochemist Reviews and a 2018 review in Endocrine Reviews. Replaced the statement that no source documented test prices with a pointer to FactHub's cost check, and linked the pediatric-care and cost checks.
  2. Version 5. Claim and rating unchanged. Added rated objections for three sentences of the No campaign's voters' pamphlet argument: the 'Section 2 ... reproductive organs' sentence (Misleading; the rule is Section 3(2) and the text says 'reproductive anatomy'), 'students remain fully clothed during sports physicals' (Mostly true), and 'girls as young as 8' (Misleading; WIAA programs run grades 7-12, or 6-12 where districts opt in). Added evidence on WIAA grade coverage and on how KUOW's June 4 story described the options as including a 'visual genital exam', with a link to FactHub's media-coverage check, plus links to the birth-certificate, most-extreme and pediatric-care checks. Correction: version 4 said sports-physical forms have no sex field; the current AAP history form, completed by the family, asks sex assigned at birth, and the exam form has no genital item but includes a femoral-pulse check. Replaced the Secretary of State text link and the Attorney General ballot-title letter, both of which moved, with the current filed-text URL and the Attorney General's explanatory statement in the voters' pamphlet; replaced the WIAA-posted interim exam form with the current AAP forms. Converted sources to quoted takeaways, set the topic to 'Washington I-638 (2026)', and corrected the disclosure to state ownership, conflicts and funding plainly.
  3. Version 6. Updated links to FactHub's companion checks: the pediatric-care check (version 2, now rated Mostly true), the birth-certificate check (version 2, now rated Misleading) and the most-extreme check (version 2). No change to the claim, rating or evidence.
  4. Updated related links to the final versions of sibling articles.
  5. Re-rated the No argument's sentence 'Today, students remain fully clothed during sports physicals' from Mostly true to Misleading: it is literally true of today's physicals, but in context it implies the measure would make girls undress, when a provider may rely on genetics, testosterone or existing knowledge from past care. Conclusion updated to match. No change to the lead claim or rating.
  6. First draft.
  7. Reworded the rated claim to match how opponents state it ("will require genital examinations") and changed the rating from Misleading (moderate confidence) to False (high confidence), since the claim concerns what the measure requires and the text contradicts it. Moved discussion of likely practical effects to a separate, unrated point.
  8. Retitled to state the finding more generally, and added a key point setting out the full range of verification routes the text permits.
  9. Added a main image: an openly licensed photo of a stethoscope (Jacek Halicki, CC BY-SA 4.0, via Wikimedia Commons).

Cited by

Version details

The exact citing versions, and the version of this article each cites.

  • Article wa-i638-yes-campaign-claims — version 2 (published) cites version 8
  • Article wa-i638-verification-accuracy — version 2 (published) cites version 9
  • Article wa-i638-verification-accuracy — version 1 (published) cites version 9
  • Article wa-i638-media-coverage-omissions — version 6 (published) cites version 8
  • Article girls-sports-participation-after-state-laws — version 6 (published) cites version 8
  • Article wa-i638-campaign-funding — version 5 (published) cites version 8
  • Article wa-i638-officials-exam-claims — version 3 (published) cites version 8
  • Article sex-verification-test-costs — version 2 (published) cites version 8
  • Article wa-i638-most-extreme — version 4 (published) cites version 8
  • Article wa-i638-exam-claim-persuasion — version 1 (published) cites version 8
  • Article wa-i638-pediatric-care-verifies-sex — version 4 (published) cites version 8
  • Article wa-i638-world-sports-policies — version 4 (published) cites version 8
  • Article wa-i638-girls-event-placements — version 5 (published) cites version 8
  • Article wa-i638-birth-certificates — version 4 (published) cites version 8
  • Article wa-girls-mile-record-vs-boys-finals — version 2 (published) cites version 4
  • Article wa-i638-current-rules — version 4 (published) cites version 8
  • Briefing wa-i-638 — version 5 (published) cites version 8
  • Briefing wa-i-638 — version 4 (published) cites version 8

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{"@context":"https://schema.org","@type":"ClaimReview","url":"https://facthub.org/n/article/wa-i638-genital-exam-claim/9","datePublished":"2026-10-12","dateModified":"2026-10-27","author":{"@type":"Organization","name":"FactHub","url":"https://facthub.org/"},"claimReviewed":"Initiative 638 will require genital examinations for female athletes.","reviewRating":{"@type":"Rating","alternateName":"False"},"image":"https://facthub.org/node-assets-v2/article/wa-i638-genital-exam-claim/9/stethoscope/social-1200x630.jpg"}

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