This chapter explores the historical evolution of family systemic therapy with a gender perspective. It describes the main intervention strategies with a gender perspective, incorporating principles of gender-affirmative therapy to address the needs of individuals with diverse identities. Additionally, the challenges and resistances that persist in the field are analyzed, including power dynamics within families and the need for continuous theoretical and practical updates. Finally, the future challenges of systemic therapy with a gender perspective are addressed, emphasizing the importance of professional training and the creation of safe and validated therapeutic spaces for all identities.