Doctors and nurses in Washington warn that an anti-transgender sports initiativewould subject girls to invasive sex-verification requirements to participate in school athletics.

Initiative 638 would bar transgender girls from girls’ school sports teams and require students competing in girls’ sports to provide verification of their sex from a healthcare provider. Under the measure’s text, that verification would have to rely on reproductive anatomy, genetic makeup, or naturally produced testosterone levels.

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Medical professionals opposing the initiative say those requirements would create barriers for cisgender girls while excluding transgender girls.

“I tell my kids and patients that my No. 1 job is to keep them safe,” Kelsey Gellner, a pediatric nurse and board member of the Washington State Nurses Association, told The Guardian. “I can say with confidence that girls do not want to have an unnecessary exam that creates an unsafe barrier.”

Dr. Libby Loft, a Spokane family physician, raised similar concerns.

“The way the measure is written says that I, as a physician, cannot rely on a birth certificate,” Loft told The Guardian. “I have to examine someone’s reproductive anatomy — that seems inappropriate to me for a sports physical.”

In an opinion essay published by The Seattle Times, Drs. Caitlin Blau, Glenna Martin, and Grace Shif and registered nurse Sam Doyle warned that the requirements could discourage girls from participating in sports.

“The initiative is a government mandate forcing us to conduct medically unnecessary and potentially harmful tests on elementary, middle and high school girls,” they wrote.

They warned that the requirements “would decrease participation, robbing girls of the physical, social and emotional benefits that sports provide.”

Republicans running for office in Washington have promoted the initiative, including congressional candidate John Braun, who has made it a focus in the closing weeks of his campaign for a battleground U.S. House seat.

Let’s Go Washington, the group backing the measure, released a poll showing 56 percent support. However, the campaign did not provide KATU with the full polling data or methodology, including the margin of error, preventing an independent evaluation of the results.

The fight is unfolding in a Democratic-leaning state where Seattle has become a haven for transgender people fleeing Republican-led states.

More than 100 pediatricians and nurses have worked with the No Hate in WA State campaign to defeat the measure.