speech therapy context, non-verbal communication may be targeted through the encouragement of focused observation, offering feedback on the client's self-defined non-verbal goals, offering information about the differences between men and women's non-verbal communication, and/or referring to peer support or expert services. Psychosocial factors While some specific psychosocial issues faced by transgender people are often addressed through psychotherapy, there are psychosocial factors that can influence transgender voice therapy. For example, some clients feel that hormone therapy for transitioning changes concentration and emotional stability, which could affect receptiveness to speech therapy. Davies and Goldberg (2006) also note that an altered voice may feel inauthentic, and it may take time for the client to feel as if their new voice is an expression of their true self. Transgender erasure describes systematic, individual, or organizational discrimination against transgender people. Informational erasure and institutional erasure were identified in a 2009 Canadian study of health care for transgender people as being the most prominent barriers to care. Informational erasure involves a lack of knowledge, or a perceived lack of knowledge, about transgender health care. This may manifest itself in health care providers being more reluctant to treat transgender clients because of an unwillingness to find information about their specific population. Institutional erasure describes policies that do not accommodate transgender identities or bodies. For example, forms, texts, or prescriptions may refer to a person by an unpreferred name or pronoun. Issues of erasure may hinder a transgender person's ability to find speech therapy services, or may affect the person's comfort with speech therapy. In addition to paying attention to problems of erasure, Adler and Christianson (2012) suggest that a clinician should be sensitive to the following areas when working with a transgender client: Gender attribution and discrimination Possible feelings of shame and guilt Consequences of the coming out process Spouse, partner, or family attitudes Employment issues Incidence of HIV/AIDS Racial and cultural differences The authors note that this is not an exhaustive list of possible psychosocial factors and that every client is different. Psychosocial factors such as these may affect a transgender client's progress and prognosis in speech therapy. Transition in childhood and adolescence Few studies have considered the potential repercussions of age on therapy. Currently, there is no consensus regarding speech therapy for adolescents. During adolescence, there is an increase of both vocal tract size and vocal fold length, especially for those assigned male at birth,