Damn.
In my neck of the woods, people of her generation just didn't have options. You either left home like she did, or you struggled to survive. I think the first trans woman I met was probably that age; we never got close since I was a damn kid, but she was closer to my mom's age for sure. She had been all over the world trying to find a place to call home, and had some real horrifying stories. And scars, literally and figuratively.
I got the impression that sex work was extremely common in the cities that you could get access to treatments and surgeries. Hard to work a regular job with no ID because you ran away in fear with no documentation at all.
But later on, the trans people I met of that age range all had similar stories, if they didn't have the "luck" of already being close to somewhere that had access to a community and help, or the much rarer fortune of supportive family.
It's infuriating that anyone should have to go through that kind of thing just to be.
I know, even back then it wasn't always the case that people had to make those choices, but it really seems to be a common thread that homelessness, addiction, and sex work were a shared experience for way more people than is even fair.