Washington State voters will decide the fate of a ballot initiative that would require girls from kindergarten through high school to undergo sex-verification testing before playing school sports — a measure critics call the most extreme of its kind in the country.

IL26-638 would bar transgender athletes from girls’ teams by mandating that a health-care provider certify a player’s sex assigned at birth, using genetic screening, testosterone testing or an examination of reproductive anatomy as part of the annual sports physical every young athlete already undergoes, reported The Cut.

“This measure was clearly not written by somebody who practices medicine,” said Dr. Gina Martin, a family medicine physician who offers sports physicals to her patients. “Physicals focus on the two most important aspects of sports. First, musculoskeletal health — thinking about kids’ joints, bones, muscles, and tendons — and then cardiac health, looking into their heart health and finding out if we need to screen for additional cardiac risk factors.”

“What is certainly not medically necessary is for me to do an exam and confirm somebody’s sex, either through hormone testing, genetic testing or a non-indicated genital exam,” Martin added. “I don’t even know how it would work because I’ve never run those tests on a patient.”

The measure doesn’t specify who would perform the exams, who would pay for them, or how schools would carry them out — leaving open questions about whether young girls could be required to disrobe, potentially in group settings where many schools currently offer free physicals.