Five-second answer

Claim we investigated

Standard primary pediatric care already verifies sex; transferring that record to sports is sufficient.

Mostly true. Regular checkups document anatomy and sex, but a quarter of Washington children lack a personal provider to sign. The AAP's Bright Futures guidelines and the standard sports-physical history form show that a child's regular doctor already has a record of her anatomy and her family-reported sex, while national survey data, the measure's text and the WIAA show that a quarter of children lack such a doctor and that the text does not say a record is enough.

Quote or cite this fact-check

FactHub rates the claim “Standard primary pediatric care already verifies sex; transferring that record to sports is sufficient” Mostly true (moderate confidence): Regular checkups document anatomy and sex, but a quarter of Washington children lack a personal provider to sign. Reviewed October 23, 2026. https://facthub.org/n/article/wa-i638-pediatric-care-verifies-sex/4

One-minute summary

What the evidence establishes

  • Established. A child's regular doctor already has a record of her sex: the AAP's Bright Futures guidelines call for a complete physical exam at every well-child visit, including a visual genital inspection of girls aged 11 through 17 to assess sexual maturity.
  • Established. The standard sports-physical history form, which the WIAA posts and marks 'STAYS WITH YOUR DOCTOR', asks the family for sex assigned at birth.
  • Established. The measure lets the provider rely on reproductive anatomy, and its text does not bar relying on anatomy observed at earlier visits.
  • Not shown. The measure never mentions records. It requires a new statement signed by the student's personal health care provider, and no implementing guidance says a prior record is enough.
  • Established. In 2023-24, 25.3% of Washington children had no personal doctor or nurse and 19.9% had no preventive checkup in the past year, so many girls have no pediatric record to transfer.
  • Context. The forms sent to schools (the Medical Eligibility Form) have no sex field; the state's sex checkbox on sports clearance forms was dropped in 2019.
  • Context. The Washington chapter of the AAP objected to being cited in the Yes argument; its director said genital exams are standard for boys and pre-pubertal girls and that there is no medical reason for sex verification for sports.
  • Established. The No side's 147,500 equals 18% of all Washington girls under 18; survey rates applied to girls aged 5 to 17 give roughly 120,000 to 150,000. Those girls could use a genetic or hormone test instead of an anatomy check.
Important context: Initiative IL26-638 is on Washington's November 3, 2026 ballot. Section 3(2) requires a student entering female-only school competition to provide, as part of the sports physical, a statement signed by her personal health care provider verifying her biological sex, relying only on reproductive anatomy, genetic makeup or normal testosterone levels. The Yes campaign's rebuttal in the voters' pamphlet says ordinary pediatric care already does this. This check rates that sentence, the Yes argument's citation of the American Academy of Pediatrics, and the No argument's count of girls without a regular doctor.

Standard primary pediatric care already verifies sex; transferring that record to sports is sufficient.

Committee for the argument for Initiative IL26-638 (Alesha Perkins and five co-authors), Authors of the official voters' pamphlet argument for IL26-638 2026 Washington voters' pamphlet, Initiative Measure IL26-638, p. 22, argument for: "Rebuttal of argument against" · · Assertion

Context: The Yes reply on how verification would work in practice.

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 4 methods across 9 institutions and 1 country or international grouping.
Evidence map
Method Institution / country Year(s) What it shows Key limitation Primary links
Review of the American Academy of Pediatrics' Bright Futures Guidelines (4th edition), middle childhood and adolescence visits American Academy of Pediatrics United States 2017 Bright Futures says a complete physical examination is included in every health supervision visit. At the 7-8 and 9-10 year visits it lists 'Breasts and genitalia: Assess for sexual maturity rating.' At the 11-14 and 15-17 year visits it lists, for females, 'Genitalia: Perform visual inspection for sexual maturity rating,' noting a pelvic exam only when clinically warranted. A provider who has followed the guidelines has therefore observed the patient's external reproductive anatomy at recent visits. These are recommendations, not a record of what clinicians do; physicians on both sides of the measure describe genital inspection of teenage girls as less routine in practice. At 18 to 21 the guidelines call for a genital exam only when concerns arise. American Academy of Pediatrics American Academy of Pediatrics
News interviews with pediatricians and family physicians on both sides, and the Washington AAP chapter director's published statements KUOW Public Radio, The Seattle Times, Them / The Advocate, Washington Chapter of the American Academy of Pediatrics United States 2026 Dr. Erica Li, a pediatrician who supports the measure and co-signed the Yes argument, told KUOW that every child seen regularly should get a brief genital exam to confirm puberty is progressing, and that doctors could use it to confirm sex without a separate inspection. Dr. Grace Shih, a family physician who opposes it and co-signed the No argument, said she would not use annual-visit information for a sports form. Dr. Eloi Hoopman told The Seattle Times genital exams are not required preventive care for older children and teenagers. The Washington AAP chapter's director wrote that genital exams are standard for all boys and pre-pubertal girls, and that there is no indication for sex verification for sports clearance. A handful of physicians quoted in news stories, most of them aligned with one campaign; no survey of Washington providers exists. The chapter director's words come from screenshots the Yes campaign published. KUOW Public Radio The Seattle Times The Advocate (reprinting Them)
Review of the filed initiative text, the sports-physical forms the WIAA posts, and reporting on WIAA practice Washington Secretary of State, Washington Interscholastic Activities Association, American Academy of Pediatrics, KUOW Public Radio United States 2019, 2025, 2026 Section 3(2) requires a statement 'signed by the student's personal health care provider that verifies the student's biological sex, relying only on' reproductive anatomy, genetic makeup or normal endogenous testosterone. It names bases, not procedures or records. The measure's findings say current physicals include documentation of sex assigned at birth. That is partly so: the standard history form, which the WIAA posts and marks as staying with the doctor, asks the family for sex assigned at birth. The forms that go to the school do not: the Medical Eligibility Form has no sex field, and KUOW reports the state's sex checkbox on clearance forms was dropped in 2019. The WIAA said enforcement would need to be worked out with medical professionals. No implementing rule exists; the WIAA, school districts and providers would decide how the requirement works if the measure passes. The text neither allows nor forbids reliance on prior findings in so many words. Washington Secretary of State American Academy of Pediatrics Washington Interscholastic Activities Association Washington Interscholastic Activities Association KUOW Public Radio
National Survey of Children's Health estimates for Washington, 2023-2024 combined, via the Data Resource Center for Child and Adolescent Health U.S. Health Resources and Services Administration (NSCH), Data Resource Center for Child and Adolescent Health United States 2023, 2024 In the 2023-24 survey, 25.3% of Washington children (about 413,000) had no personal doctor or nurse, defined as one or more health professionals who know the child well and are familiar with the child's health history, and 19.9% (about 324,000) had no preventive medical visit in the past 12 months. Parent-reported survey of about 1,500 Washington children with sampling error (95% interval for no personal doctor or nurse: 22.2% to 28.8%). Figures cover boys and girls aged 0-17; we did not find a girls-only Washington estimate. A child without a personal doctor may still have records from clinics or urgent care. Data Resource Center for Child and Adolescent Health (NSCH) Data Resource Center for Child and Adolescent Health (NSCH)
1. AAP guidelines call for checking girls' genital development at checkups from 7 to 17 Review of the American Academy of Pediatrics' Bright Futures Guidelines (4th edition), middle childhood and adolescence visits

Bright Futures says a complete physical examination is included in every health supervision visit. At the 7-8 and 9-10 year visits it lists 'Breasts and genitalia: Assess for sexual maturity rating.' At the 11-14 and 15-17 year visits it lists, for females, 'Genitalia: Perform visual inspection for sexual maturity rating,' noting a pelvic exam only when clinically warranted. A provider who has followed the guidelines has therefore observed the patient's external reproductive anatomy at recent visits.

Limit: These are recommendations, not a record of what clinicians do; physicians on both sides of the measure describe genital inspection of teenage girls as less routine in practice. At 18 to 21 the guidelines call for a genital exam only when concerns arise.

Verify: Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed.: Adolescence Visits (11 through 21 years) Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed.: Middle Childhood Visits (5 through 10 years)

2. Physicians disagree on whether checkup findings should be used for a sports form News interviews with pediatricians and family physicians on both sides, and the Washington AAP chapter director's published statements

Dr. Erica Li, a pediatrician who supports the measure and co-signed the Yes argument, told KUOW that every child seen regularly should get a brief genital exam to confirm puberty is progressing, and that doctors could use it to confirm sex without a separate inspection. Dr. Grace Shih, a family physician who opposes it and co-signed the No argument, said she would not use annual-visit information for a sports form. Dr. Eloi Hoopman told The Seattle Times genital exams are not required preventive care for older children and teenagers. The Washington AAP chapter's director wrote that genital exams are standard for all boys and pre-pubertal girls, and that there is no indication for sex verification for sports clearance.

Limit: A handful of physicians quoted in news stories, most of them aligned with one campaign; no survey of Washington providers exists. The chapter director's words come from screenshots the Yes campaign published.

Verify: Transgender ballot initiative could require genital exams for WA secondary school students (Sarah Mizes-Tan, June 4, 2026) Despite objections, doctors group cited in WA voter guide on trans sports ban (Elise Takahama, August 27, 2026) Pediatrics association tells transphobes not to use its name to push for school sports genital exams (August 2026)

3. The measure requires a new provider-signed statement; the doctor's file already holds a self-reported sex Review of the filed initiative text, the sports-physical forms the WIAA posts, and reporting on WIAA practice

Section 3(2) requires a statement 'signed by the student's personal health care provider that verifies the student's biological sex, relying only on' reproductive anatomy, genetic makeup or normal endogenous testosterone. It names bases, not procedures or records. The measure's findings say current physicals include documentation of sex assigned at birth. That is partly so: the standard history form, which the WIAA posts and marks as staying with the doctor, asks the family for sex assigned at birth. The forms that go to the school do not: the Medical Eligibility Form has no sex field, and KUOW reports the state's sex checkbox on clearance forms was dropped in 2019. The WIAA said enforcement would need to be worked out with medical professionals.

Limit: No implementing rule exists; the WIAA, school districts and providers would decide how the requirement works if the measure passes. The text neither allows nor forbids reliance on prior findings in so many words.

Verify: Initiative Measure No. IL26-638, final filed text (filed June 2, 2025) Preparticipation Physical Evaluation: History Form (PPE 5th edition, revised) WIAA Forms: Health and Wellness Forms (accessed October 23, 2026) Preparticipation Physical Evaluation: Medical Eligibility Form (2019 multi-society form, as posted by WIAA) Transgender ballot initiative could require genital exams for WA secondary school students (Sarah Mizes-Tan, June 4, 2026)

4. One in four Washington children has no personal doctor or nurse National Survey of Children's Health estimates for Washington, 2023-2024 combined, via the Data Resource Center for Child and Adolescent Health

In the 2023-24 survey, 25.3% of Washington children (about 413,000) had no personal doctor or nurse, defined as one or more health professionals who know the child well and are familiar with the child's health history, and 19.9% (about 324,000) had no preventive medical visit in the past 12 months.

Limit: Parent-reported survey of about 1,500 Washington children with sampling error (95% interval for no personal doctor or nurse: 22.2% to 28.8%). Figures cover boys and girls aged 0-17; we did not find a girls-only Washington estimate. A child without a personal doctor may still have records from clinics or urgent care.

Verify: NSCH 2023-24: Medical Home Component: Personal doctor or nurse, Washington NSCH 2023-24: One or more preventive care visits during past 12 months, Washington

Common questions

“Students would compete in the category that aligns with their sex, verified during routine, medically necessary primary care recommended by the American Academy of Pediatrics.”

Our rating: Mostly true

The AAP does recommend routine checkups, and its Bright Futures guidelines include a visual genital inspection of girls through age 17, as Let's Go Washington pointed out; a provider who follows them has observed the anatomy the measure lets a provider rely on. What the sentence leaves out is that the AAP does not endorse using that care for sex verification: its Washington chapter asked to be removed from the pamphlet, and its director said there is no medical indication for sex verification for sports. The measure itself puts the signed statement in the sports physical, not the checkup.

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

Our rating: Misleading

The campaign has not published its method, and its website says 'an estimated 150,000 school age girls'. The figure is in a defensible range: 147,500 is 18.4% of Washington's 800,668 girls under 18 (Census 2024), close to the 18% of children The Seattle Times reported lack consistent access to care, and NSCH rates applied to the roughly 600,000 girls aged 5 to 17 give about 120,000 to 150,000. But the count includes every girl, not the far smaller number entering girls' sports in a given year, and the measure lets a girl's provider rely on a genetic or testosterone test instead of anatomy. Girls without a regular doctor would face a provider who does not know them, and some may choose an anatomy check as the cheapest route, but 'would be subject to genital examinations' overstates what the text requires.

Related claim: Initiative 638 requires a doctor's sex verification, not a genital exam. — FactHub rates the claim that I-638 will require genital examinations False (high confidence): Initiative 638 requires a doctor's sex verification, not a genital exam. This links to the version that was current when this fact check was written. Read the latest version.

“The measure forbids doctors from relying on a child's existing records.”

Short answer: Not clearly

The text limits what a provider may rely on (anatomy, genetics or testosterone), not when or how the provider learned it. Anatomy observed and recorded at a recent checkup is still anatomy. Birth certificates and the sex marker in a chart are different: they are not among the three bases, a point the sibling article on birth certificates covers. How providers and the WIAA would treat prior findings has not been decided.

Related claim: Under I-638, a birth certificate alone can't prove a girl's sex for sports. — FactHub rates the No claim that I-638 bans parents from using birth certificates Misleading: under I-638, a birth certificate alone can't prove a girl's sex for sports, but the text never mentions birth certificates.

“Sports physicals already document a student's sex, as the measure's findings say.”

Short answer: Self-reported, in the doctor's file

Partly. The standard history form, which the WIAA posts and marks 'STAYS WITH YOUR DOCTOR', asks the family for 'Sex assigned at birth (F, M, or intersex)', so the family's own report is already in the doctor's file. The physical examination form has no sex field, and the Medical Eligibility Form, the one the WIAA says to give to the school, has none either; KUOW reports that the state dropped a sex checkbox from clearance forms sent to schools in 2019. So the doctor usually has a self-reported sex on file, but no form now records a provider's verification of it.

“Genital exams are not part of standard care for teenage girls.”

Short answer: Guidelines say they are

The AAP's guidelines list a visual genital inspection for sexual maturity rating for girls at the 11-14 and 15-17 year visits. Some physicians, including the Washington AAP chapter's director, describe genital exams as standard only for pre-pubertal girls, and opponents say they are not routinely done for teenagers in practice. The guidelines support the Yes side's description of standard care; practice appears to vary, and no Washington data measure how often the inspection is done.

Conclusion

The Yes rebuttal's main point holds for most girls. A child's pediatrician or regular doctor knows the child's biological sex: the American Academy of Pediatrics' Bright Futures guidelines, the national standard for well-child visits, call for a complete physical examination at every visit and, for girls aged 11 through 17, a visual inspection of the genitalia to assess sexual maturity rating; for ages 7 through 10 they call for assessing sexual maturity rating of the breasts and genitalia. So a provider who has followed the guidelines has observed the girl's reproductive anatomy, one of the three bases Section 3(2) allows. The sports physical adds a family-reported record too: the standard history form, which the WIAA posts and marks 'STAYS WITH YOUR DOCTOR', asks 'Sex assigned at birth (F, M, or intersex)'. A pediatrician who supports the measure told KUOW that doctors could use earlier findings rather than a separate inspection, and on a plain reading nothing in the text stops a provider from relying on anatomy observed at an earlier visit. For a girl in regular care, signing the statement can be a matter of the doctor confirming what the chart already shows. Three caveats keep the sentence from being fully true. First, 'standard' care is not universal: in the 2023-24 National Survey of Children's Health, 25.3% of Washington children had no personal doctor or nurse and 19.9% had no preventive visit in the past year. For those girls there is no pediatric record to transfer, and verification would be a new step with a provider who does not know them. Second, the measure never mentions records. It requires a new statement signed by the student's personal health care provider; whether a prior record suffices will depend on providers and on implementing guidance that the WIAA says has not been worked out. Third, practice varies more than the guidelines suggest: the Washington AAP chapter's director, in messages the Yes campaign published, described genital exams as standard for all boys and pre-pubertal girls and said there is 'no indication for sex verification' for sports clearance, and one family physician who opposes the measure said she would not use annual-visit findings to sign a sports form. The history form's sex entry is the family's own report, not a provider's verification. None of these contradicts the main point; each limits how far 'already verifies' and 'sufficient' reach. The Yes argument's related line, that sex would be 'verified during routine, medically necessary primary care recommended by the American Academy of Pediatrics', is Mostly true on the same evidence: the AAP does recommend those checkups and the genital inspection within them, though its Washington chapter objected to being cited and says no medical reason exists for sex verification. The No argument's '147,500 girls without a regular family doctor' is in a defensible range (it matches 18% of Washington's roughly 800,700 girls under 18, and NSCH rates applied to the 600,000 girls aged 5 to 17 give about 120,000 to 150,000), but it counts all girls rather than those entering girls' sports, and the measure lets those girls use a genetic or hormone test instead of a genital examination. We rate it Misleading. Confidence is Moderate because how providers and the WIAA would apply the text is not yet settled, and no Washington data measure how closely practice follows the AAP guidelines.

How we checked

  1. Defined the lead claim as the exact Yes rebuttal sentence in the 2026 voters' pamphlet, and split it into two parts: whether standard pediatric care documents sex, and whether that record would satisfy the measure.
  2. Read the AAP's Bright Futures Guidelines (4th edition) physical-examination sections for the 7-8, 9-10, 11-14, 15-17 and 18-21 year visits.
  3. Read Section 3(2) and Section 1 of the filed initiative text, and the WIAA-posted Medical Eligibility Form.
  4. Reviewed reporting by KUOW (June 2026), The Seattle Times (March and August 2026) and Them/The Advocate (August 2026), giving equal weight to physicians who support and oppose the measure.
  5. Queried the National Survey of Children's Health (2021-2024) for Washington children without a personal doctor or nurse and without a preventive visit, and the Census Bureau's 2024 American Community Survey for Washington girls by age, to test the No side's 147,500.
  6. Looked for the No campaign's method for 147,500 and for any public AAP statement on the measure; found neither.
  7. Recorded limits for each line of evidence and requested Wayback Machine archives of every source.

Editorial note: Scope: this article rates the Yes rebuttal sentence on pediatric records, the Yes argument's citation of the American Academy of Pediatrics, and the No argument's 147,500 figure, all from the 2026 Washington voters' pamphlet. Whether the measure requires genital examinations, and whether birth records count, are checked in sibling FactHub articles. The No campaign has not published how it reached 147,500; the reconstruction here is our own. The National Survey of Children's Health figures cover all Washington children 0-17, not girls only. The AAP's national office and Washington chapter declined to comment to reporters; the chapter director's statements are as published by Let's Go Washington and reported by Them and The Advocate. FactHub takes no position on I-638. 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. 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 and widely used as the standard of care. The AAP opposes laws like I-638, but these guidelines predate the measure and do not address sports eligibility.

    • Qualifies: Bright Futures calls for a complete physical exam at every well-child visit.

      What the source says
      A complete physical examination is included as part of every health supervision visit.
      Early Adolescence, 11 Through 14 Year Visits, Physical Examination, p. 740

    • Qualifies: For girls aged 11 to 14, 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. … A pelvic examination may be clinically warranted, based on specific problems.
      11 Through 14 Year Visits, Physical Examination, Genitalia, pp. 740-741

    • Qualifies: The same visual genital inspection is listed for girls aged 15 to 17.

      What the source says
      important for adolescents aged 15 through 17 years. … Genitalia … Female … Perform visual inspection for sexual maturity rating.
      15 Through 17 Year Visits, Physical Examination, pp. 772-773

    • From 18 to 21, a female genital exam is listed only as indicated by concerns.

      What the source says
      important for young adults aged 18 to 21 years: … Genitalia … Female … Perform examination as indicated by patient or practitioner concerns.
      18 Through 21 Year Visits, Physical Examination
  2. 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.

    • Qualifies: 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)
  3. News report KUOW Public Radio. Transgender ballot initiative could require genital exams for WA secondary school students (Sarah Mizes-Tan, June 4, 2026)

    News report with interviews of a pediatrician who supports the measure, a family physician who opposes it, and the WIAA.

    Reliability: Seattle public radio newsroom. The physicians quoted are signers of the Yes (Li) and No (Shih) pamphlet arguments.

    • Qualifies: A pediatrician who supports the measure says doctors could rely on genital exams from regular checkups instead of a new inspection.

      What the source says
      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.
      Paragraphs quoting Dr. Erica Li · Dr. Erica Li, pediatrician, co-author of the Yes argument

    • A family physician who opposes the measure says she would not use annual-visit findings to fill in a sports form.

      What the source says
      She said she wouldn’t feel comfortable using information from a kid’s annual appointments to satisfy a new section on a sports form.
      Paragraph quoting Dr. Grace Shih · Dr. Grace Shih, family physician, co-author of the No argument

    • Washington sports clearance forms sent to schools have had no sex checkbox since 2019.

      What the source says
      The state previously required sports clearance forms to include a checkbox to indicate sex, but in 2019 the policy changed. That checkbox no longer appears on forms sent to schools
      Paragraph after the WIAA quote

    • The WIAA says how verification would work has not been worked out.

      What the source says
      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.
      Quote from Justin Kesterson · Justin Kesterson, assistant executive director, WIAA
  4. News report The Seattle Times. Despite objections, doctors group cited in WA voter guide on trans sports ban (Elise Takahama, August 27, 2026)

    News report on the AAP's request to be removed from the Yes argument and both sides' responses.

    Reliability: Statewide daily newspaper. Quotes the Secretary of State's office, Let's Go Washington and a physician who opposes the measure; the AAP declined to comment.

    • The AAP asked not to be referenced in the Yes argument, and the committee declined to change it.

      What the source says
      The AAP told the committee it didn’t want to be referenced, but committee members decided against making the change, said Hallie Herzberg, a spokesperson for Let’s Go Washington.
      Fifth paragraph

    • Qualifies: Let's Go Washington says the line cites the AAP's wellness guidelines and does not claim AAP endorsement.

      What the source says
      doesn’t assert an endorsement or requirement of exams in sports physicals, it simply states what the AAP recommends in their own wellness guidelines,
      Paragraph quoting the Let's Go Washington news release · Let's Go Washington news release

    • A family physician who opposes the measure says genital exams are not required preventive care for teenagers.

      What the source says
      These appointments can include genital exams for children under a certain age, or for clinical reasons, but they’re not required as part of preventive care for older kids or teenagers, Hoopman said.
      Paragraph quoting Dr. Eloi Hoopman · Dr. Eloi Hoopman, Pierce County family physician who opposes the measure
  5. News report The Seattle Times. WA voters to see ballot initiative aimed at trans girls in sports (March 5, 2026)

    News report on the measure with the access-to-care figure the No side's number appears to draw on, and the Yes campaign's account of verification.

    Reliability: Statewide daily newspaper; it cites the Data Resource Center for the 18% figure without naming the indicator.

    • Qualifies: The Seattle Times reported that about 18% of Washington children lack consistent access to medical care.

      What the source says
      About 18% of Washington children lack consistent access to medical care
      Paragraph on access to care

    • Qualifies: Let's Go Washington says an existing doctor-patient relationship will often make any new test unnecessary.

      What the source says
      Often, none of those things would be needed because of the existing relationship or other procedures that a doctor has to do during a sports physical.
      Quote from Hallie Herzberg · Hallie Herzberg, director of communications, Let's Go Washington
  6. Advocacy group The Advocate (reprinting Them). Pediatrics association tells transphobes not to use its name to push for school sports genital exams (August 2026)

    Report on the AAP dispute that quotes both statements by the Washington AAP chapter's executive director from screenshots Let's Go Washington published.

    Reliability: Has a stake in this finding. LGBTQ outlet that opposes the measure, as its headline shows. Used only for the two quoted lines from the chapter director, both from Let's Go Washington's own release.

    • Qualifies: The Washington AAP chapter's director wrote that genital exams are standard at well checks for all boys and for pre-pubertal girls.

      What the source says
      genital exams are standard for annual well checks in all boys and in all pre-pubertal girls,
      Paragraph on LGW's screenshots · Executive director, Washington Chapter of the AAP (as published by Let's Go Washington)

    • The same director wrote that there is no medical reason for sex verification to clear a child for sports.

      What the source says
      no indication for sex verification to obtain medical clearance to participate safely in sports.
      Paragraph on LGW's screenshots · Executive director, Washington Chapter of the AAP (as published by Let's Go Washington)
  7. 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.

    • In 2023-24, 25.3% of Washington children (95% CI 22.2-28.8%, about 413,000) had no personal doctor or nurse.

      What the source says
      Does not have a personal doctor or nurse … 25.3
      Results table, Washington, 2023-2024
  8. Government Data Resource Center for Child and Adolescent Health (NSCH). NSCH 2023-24: One or more preventive care visits during past 12 months, Washington

    National Survey of Children's Health estimate of Washington children with and without a preventive medical visit in the past year, 2023-2024 combined.

    Reliability: Federal NSCH data (HRSA and Census Bureau) presented by the Child and Adolescent Health Measurement Initiative.

    • In 2023-24, 19.9% of Washington children (about 324,000) had no preventive medical visit in the past 12 months.

      What the source says
      No preventive care visits … 19.9
      Results table, Washington, 2023-2024
  9. Government U.S. Census Bureau. American Community Survey 2024 1-year, Table B01001: Sex by Age, Washington

    Census estimates of Washington's population by sex and age, used to size the number of girls under 18 and aged 5 to 17.

    Reliability: Official Census Bureau survey estimate; female age groups under 5, 5-9, 10-14 and 15-17 sum to 800,668, and the 5-17 groups to 599,939 (margins of error 2,500 to 7,000 per group).

    • Qualifies: Washington had about 800,668 girls under 18 in 2024, of whom 599,939 were aged 5 to 17.

      What the source says
      200,729 … 229,515 … 229,204 … 141,220
      Female: Under 5 years; 5 to 9 years; 10 to 14 years; 15 to 17 years (Washington)
  10. Party to the dispute No Hate in WA State. About I-638 (campaign website, accessed October 23, 2026)

    The No campaign's explanation of the measure, with its version of the regular-doctor figure.

    Reliability: Has a stake in this finding. The committee that wrote the No argument. It gives no source or method for the figure.

    • Qualifies: The No campaign's website says about 150,000 school-age girls lack a regular family doctor, without citing a source.

      What the source says
      To comply with I-638, many girls seeking a sports physical will have to be genitally inspected by a stranger because an estimated 150,000 school age girls in Washington do not have access to a regular family doctor.
      Section explaining the measure
  11. 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 Section 1 the findings.

    Reliability: The official filed text as published by the Secretary of State; the measure itself was written by its sponsors.

    • The provider may rely only on anatomy, genetics or normal testosterone; the text names no procedure and does not mention records.

      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.
      Section 3(2)

    • Verification takes a statement signed by the student's personal health care provider, as part of the sports physical.

      What the source says
      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
      Section 3(2)

    • Qualifies: The measure's findings say current physicals already document sex assigned at birth.

      What the source says
      which includes documentation of the student's sex assigned at birth
      Section 1(1)
  12. Government Washington Interscholastic Activities Association. Preparticipation Physical Evaluation: Medical Eligibility Form (2019 multi-society form, as posted by WIAA)

    The clearance form a provider signs for school sports; it asks for name and date of birth, not sex.

    Reliability: The form posted by the association that governs Washington school sports; it notes that the examination findings stay in the provider's office.

    • Only the Medical Eligibility Form goes to the school, and it has no field for sex.

      What the source says
      The Medical Eligibility Form is the only form that should be submitted to a school or sports organization
      Header note, page 1
  13. Academic American Academy of Pediatrics. Preparticipation Physical Evaluation: History Form (PPE 5th edition, revised)

    The standard family-completed history form for the sports physical, from the 2019 multi-society PPE monograph.

    Reliability: Published by the American Academy of Pediatrics with five other medical societies; it predates I-638. The family, not the provider, fills in the sex entry.

    • Qualifies: The standard history form asks the family to record the athlete's sex assigned at birth.

      What the source says
      Sex assigned at birth (F, M, or intersex):
      History form, page 1
  14. Other Washington Interscholastic Activities Association. WIAA Forms: Health and Wellness Forms (accessed October 23, 2026)

    The WIAA's forms page, which links the three sports-physical forms and says which stays with the doctor and which goes to the school.

    Reliability: The association that governs Washington school sports and would carry out I-638 for its member schools.

    • Qualifies: The history form stays with the doctor; only the Medical Eligibility Form goes to the school.

      What the source says
      The recommended pre-participation history – STAYS WITH YOUR DOCTOR … The recommended medical clearance form – GIVE TO YOUR SCHOOL
      Health & Wellness Forms section
  15. FactHub dataset Initiative 638: the campaigns' claims in their own words
    • Standard primary pediatric care already verifies sex; transferring that record to sports is sufficient.
      Committee for the argument for Initiative IL26-638 (Alesha Perkins and five co-authors), Authors of the official voters' pamphlet argument for IL26-638, · In the dataset
    • Students would compete in the category that aligns with their sex, verified during routine, medically necessary primary care recommended by the American Academy of Pediatrics.
      Committee for the argument for Initiative IL26-638 (Alesha Perkins and five co-authors), Authors of the official voters' pamphlet argument for IL26-638, · In the dataset
    • Many of Washington's 147,500 girls without a regular family doctor would be subject to genital examinations by total strangers.
      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. First draft.
  2. Version 2. Changed the rating from Misleading to Mostly true: the evidence shows a child's regular doctor already has a record of her anatomy (Bright Futures) and of her family-reported sex (the standard sports-physical history form, which the WIAA posts as staying with the doctor); the missing personal provider for about a quarter of children, the text's silence on records and the lack of guidance are now presented as the reasons it is not fully True. Rerated the Yes argument's AAP-citation sentence Mostly true for consistency. Added the AAP history form and the WIAA forms page as sources, and corrected the 2019 checkbox wording to say the state dropped it. Replaced the moved Secretary of State text link. Added links to the other I-638 fact checks.
  3. Updated related links to the final versions of sibling articles.
  4. Updated related links to the final versions of sibling articles.

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 4
  • Article wa-i638-verification-accuracy — version 2 (published) cites version 4
  • Article wa-i638-verification-accuracy — version 1 (published) cites version 4
  • Article wa-i638-media-coverage-omissions — version 6 (published) cites version 4
  • Article girls-sports-participation-after-state-laws — version 6 (published) cites version 4
  • Article wa-i638-campaign-funding — version 5 (published) cites version 4
  • Article wa-i638-genital-exam-claim — version 9 (published) cites version 4
  • Article wa-i638-officials-exam-claims — version 3 (published) cites version 4
  • Article sex-verification-test-costs — version 2 (published) cites version 4
  • Article wa-i638-world-sports-policies — version 4 (published) cites version 4
  • Article wa-i638-girls-event-placements — version 5 (published) cites version 4
  • Article wa-i638-current-rules — version 4 (published) cites version 4
  • Briefing wa-i-638 — version 5 (published) cites version 4
  • Briefing wa-i-638 — version 4 (published) cites version 4

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{"@context":"https://schema.org","@type":"ClaimReview","url":"https://facthub.org/n/article/wa-i638-pediatric-care-verifies-sex/4","datePublished":"2026-10-23","dateModified":"2026-10-23","author":{"@type":"Organization","name":"FactHub","url":"https://facthub.org/"},"claimReviewed":"Standard primary pediatric care already verifies sex; transferring that record to sports is sufficient.","reviewRating":{"@type":"Rating","alternateName":"Mostly true"},"image":"https://facthub.org/node-assets-v2/article/wa-i638-pediatric-care-verifies-sex/4/exam-room/social-1200x630.jpg"}

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Technical details: node handle article:wa-i638-pediatric-care-verifies-sex:4