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.