Physicians: Rule that doctors ID athlete’s sex at birth ‘inappropriate’ for school physical

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Pediatricians and advocates urged the Nevada Interscholastic Activities Association (NIAA) to remove a new requirement on sports physical evaluations that physicians identify a student’s birth sex and recommend whether they should play boys’ or girls’ sports, calling it “medically inappropriate.”

The request came in the form of a letter signed by 18 doctors and medical professionals sent via email last week to Executive Director Timothy Jackson, who leads the association that governs high school sports in Nevada. “If the NIAA needs this information about student athletes they should ask the students or families directly,” reads the letter shared with The Nevada Independent. “Requiring physicians to identify sex at birth and make determinations about team placement extends beyond the scope of medical evaluation and into areas that are not within the purview of medical professionals.”

Additionally, the letter noted that the form requirements could represent a breach of confidentiality that has the potential to undermine trust between patients and health care providers.

The form change came after the association’s board, which is composed of school sports officials, educators, health care professionals and parents, voted in April to reverse a 2014 policy that allowed transgender students to participate in sports that align with their preferred gender identity rather than their sex assigned at birth.

The reversal followed federal guidance changes. President Donald Trump and supporters, including Republican Lt. Gov. Stavros Anthony — who is spearheading a task force at keeping transgender athletes out of women’s sports — have said transgender girls are taking opportunities away from their cisgender counterparts, have an unfair advantage and also put their peers at risk of injury.

The sports association stated in a FAQ document and a letter replying to the June 10 message from the Nevada Chapter of the American Academy of Pediatrics (Nevada AAP), that the policy change was to comply with Title IX, a federal civil rights law that prohibits sex-based discrimination in any school or any other education program that receives funding from the federal government, and an executive order by Trump that aims to prohibit transgender athletes from participating in girls’ sports.

“(It) is of the utmost importance to the NIAA to ensure female athletes are not discriminated against or placed in danger if biological males are allowed to compete in women’s sports,” Jackson, the association director, wrote in his reply to the Nevada AAP.

Outside of a handful of examples highlighted in conservative and British media outlets that Anthony’s task force shared with The Indy, there is scant evidence in Nevada of transgender athletes hurting female students during competition or hindering their opportunities. Anthony said in January he didn’t have any data on how many transgender athletes are competing on Nevada high school or college teams. The Washoe County School District said on Thursday it didn’t know how many student athletes are transgender, and the Clark County School District said it doesn’t track this type of information.

The sports association said on Thursday it couldn’t provide data on the number of transgender high school students for privacy reasons.

Dr. Terence McAllister, president of Nevada AAP, said a student athlete’s sex at birth has nothing to do with a child’s ability to play sports and the physical’s requirement to note whether a student is cleared for male or female sports is outside the scope of a medical professional.

“(These physicals are) asking the pediatricians to look at the patient and say, ‘Is this individual healthy and fit to participate in sports?’, and that’s what we answer,” McAllister said. “Anything beyond that is entering into political questions.”

McAllister said he was also concerned that families might feel the need to lie to their physician about medical history in order for their student to play on their preferred sports team. He said this potentially undermines the patient-doctor relationship and raises questions about how much families can trust their doctor.

Jackson said in a Thursday statement the sports association appreciates Nevada AAP’s input and any potential changes to the form would include feedback from member schools, the association’s legal counsel, its sport medicine advisory committee and the association’s staff. Jackson acknowledged that the form was initially changed before consulting its sports medicine advisory committee.

The June revision allows physicians to use a patient’s past medical history to answer the sex at birth question rather than relying on their observation or performing any tests that would normally not be part of a high school sports physical.

The NIAA also discussed the association’s Sept. 20 letter during the board’s Tuesday meeting, where the board approved the revision. NIAA attorney Paul Anderson said he couldn’t understand the medical association’s ongoing concerns with the form even after the tweak.

“I scratch my head,” he said in the meeting. “I mean they all went to medical school, and they all have patient admission forms whenever you go to the doctor, which usually ask who you are and what you are. I guess they don’t want to be the individual that has to check that.”

McAllister responded to the comments by noting that the form adds a paperwork burden on already busy physicians and could jeopardize a patient’s ability to talk with their doctor in an open and truthful manner.

“I have lots of information about families, about the kids, that the school might want to have, but I don’t share that with them. I don’t need to,” he said. “It’s the parents’ and the student’s responsibility to share the information that they want to with the school.”

Email records obtained by The Nevada Independent indicate that the Nevada AAP initially reached out to the sports association in June to address the changes on the physical. Those records also indicate that the initial form was made without feedback from doctors volunteering on the association’s Sports Medicine Advisory Committee.

Dr. Mitchell Strominger, immediate past president of the Nevada AAP, and one of the signers of the letter, told The Nevada Independent that asking medical professionals to make a determination about sex at birth was ill advised without doctors’ input.

Lee McAllister, executive director of the Nevada AAP, said there are no seats allocated on the board for pediatricians or mental health professionals.

“I can accept that we just see the world differently,” Lee McAllister said. “However, us not being athletic directors and them not being physicians, that should be enough for them to say, ‘OK, maybe we need to listen to the physicians on this. This is their world, not ours.’ Especially when we try so hard to give them that space.”

Though emails from officials in the sports association indicated they believed the guidance change should “resolve any concerns within the medical profession,” physicians who were on the body’s volunteer advisory committee said it “might be a stretch” to assume that.

“I think medical professionals have concerns with every change you made on the form,” one physician who declined to be interviewed wrote.

In response to the changes on the form, the Nevada State Medical Association recently passed a resolution at its 2025 annual meeting aimed at “defending the privacy of minors and doctor-patient relationships in sports physical examinations.”

The resolution noted that the association opposes any policy put forward by the sports association’s board that seeks to mandate sensitive examinations of minors or require birth certificate presentation for gender verification. The resolution also stated that the association advocates for “substantive physician input in future discussions” over physicals required by NIAA.

Dr. Andy Pasternak, a family physician in Reno, said the changes to the form focused on birth sex raise questions about athletes who may have a genetic condition that means they do not have the standard XY or XX chromosome demarcating someone as male or female.

“The number of instances of either transgender athletes or athletes with sort of intersex characteristics are relatively low,” Pasternak said. “We’re creating a lot of work for something that’s a relatively rare issue.”

As Nevada AAP waits to hear back from the sports association, Lee McAllister said some of her members have chosen to leave that section of the form blank or have gotten around it by clearing students for girls’ and boys’ sports.

During the Sept. 23 NIAA board meeting, Jackson said some schools have reported cases of doctors crossing out the section. He clarified that the form, including the portion on the student’s sex at birth, must be completed in its entirety to be accepted, but so far no school has reported not being able to find a doctor willing to do that.

McAllister said ultimately this is confidential information that should only stay between the doctor’s office and the students’ family.

“This is opening up that door that is not needed for the child to safely play sports,” she said.

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This story was originally published by The Nevada Independent and distributed through a partnership with The Associated Press.