This article explores a case of a female who presented herself as a male to an accident and emergency department, where her father collaborated with her. This case is explored from many perspectives. Safeguarding is considered from both the welfare of this young person, and from their desire to be admitted to a children's ward. Gender dysmorphisim is becoming increasingly more recognised in the UK, yet it remains rare and is considered here as many nurses will not have encountered it. In a challenging situation, as presented here, the role of the nurse remains unchanged and a family-centred care approach must continue to be practised, while ensuring the care environment is safe for all concerned.