CLEVELAND (WJW) — An Ohio bill would require high school students whose birth-assigned sex is disputed or questioned to undergo a physician’s examination of their genitals in order to play sports.

During a remote press call Thursday, Democratic state representatives and several health experts expressed their opposition to House Bill 151, saying it targets transgender youth specifically but could also impact all high school athletes.

The bill passed the Republican-controlled Ohio House last week.

“We stand to protect all children from child sexual abuse … as state-sanctioned child sexual abuse, which we believe this particular piece of legislation is,” said Democrat Representative Jessica Miranda.

Eliana Turan, a board member at the LGBTQ Community Center of Greater Cleveland, said the bill was not based on any data and called it dangerous and scary for all Ohio youth.

“Unfortunately, Ohio has elected officials who are fomenting and recycling a lot of harmful narratives that are coming from hate groups and other anti-LGBTQ lobbies,” said Turan.

Under the bill, if an athlete’s birth-assigned sex is disputed, they would be required to establish their sex by presenting a signed doctor’s statement indicating sex based on an internal and external reproductive anatomy exam, testosterone levels, and analysis of the child’s “genetic makeup.”

State Representative Beth Liston called the bill part of an extremist agenda.

“According to the Ohio High School Athletic Association, there is one child who is playing high school sports in Ohio that is a transgender student,” said Rep. Liston. “However, this bill is harming every child in Ohio, and I want to make sure everyone is aware of that.”

The bill states participants deprived of athletic opportunity or “suffers direct or indirect harm” as a result of a violation can sue for damages against the school, school district or interscholastic conference or organization.

“These are not normal exams,” said OhioHealth OB/GYN Dr. Anita Somani. “You don’t prove gender by doing a blood test or by doing a physical exam.”

Akron-based CANAPI, an LGBTQ resources organization, called the bill a “tragic example of both a denial and loss of human rights” in a statement.

“This bill is not based on any scientific or empirical evidence, it is based on bigotry and hatred,” said Rebecca Callahan, the organization’s executive director.

“With social media and everything else, now you’re putting institutional bullying on top of it,” said Turan. “I think that if this bill were to come to fruition, and I pray it won’t, I fear that we’re going to have a lot of young people who are going to carry the trauma of this for generations.”

Nationally, at least 18 states have enacted laws banning or limiting transgender athlete participation in sports, The New York Times reports. Earlier this week, Louisiana’s Fairness in Women’s Sports Act became law, despite opposition and lack of signature by Democratic Gov. John Bel Edwards. The act requires K-12 schools to assign sports teams based on biological sex assigned at birth.

States that ban transgender athletes from playing on teams corresponding with their gender identities are: Alabama, Arizona, Arkansas, Florida, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Montana, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah and West Virginia.

Several other actions unrelated to sports are also happening nationwide. In Texas, Gov. Greg Abbott previously directed the state’s Department of Family and Protect Services to investigate parents who help their kids get gender-affirming care. In March, Florida passed its House Bill 1557, referred to as the “Don’t Say Gay” bill, which not only prevents teachers from discussing LGBTQ+ issues in classrooms but allows parents/guardians to sue teachers and/or schools who discuss these topics.

It’s important to note the difference between “sex” and “gender,” which are generally not intended to be used interchangeably. As the research-based nonprofit The Conversation explains, “sex” typically refers to bodily organs or attributes assigned at birth that are used to “refer to a binary of being either female or male.” On the other hand, “gender” is how sexes are typically thought of (social roles and behaviors) — gender is ideas, rather than something physical. A person’s “gender identity,” meanwhile, refers to how an individual expresses (pronouns, style of dress, etc.) their own gender, regardless of societal ideas of how they should express it.

A trans person also does not need to undergo surgery to consider themselves transgender, Johns Hopkins Medicine explains. Many transgender people either can’t afford expensive affirming surgeries, or else, don’t feel it’s something they need.