Gender incongruence in adolescents is an increasingly common clinical problem in child psychiatry, often associated with significant psychological distress. When accompanied by depressive symptoms and school refusal, it poses a considerable diagnostic and therapeutic challenge. This article presents the case of a 14-year-old adolescent girl, seen for school withdrawal and mood disorder, in whom persistent gender incongruity was identified. The proposed clinical analysis aimed to explore the psycho-pathological links between gender identity, depression and dropping out of school, and discussed the clinical and ethical implications. In this context, care raises many questions around consent, the temporality of decisions, and the potential psychiatrization of the adolescent journey. It is essential to provide a space for free speech, without any specific direction. The role of caregivers is to enable a safe exploration of identity, while avoiding premature medical projections.