Another thing you run into with a fifth wheel, aside from height, is bedrail clearance. I have a 6" lift (axle flip) on my fifth wheel and have really good bedrail clearance, but I've still come close to hitting in some situations. The scenario that seems most common is climbing up a steep road and pulling from it onto a flat road (or vise versa). Basically your truck is on one surface and the trailer is on the other. But you do get a shorter overall length and much better towing characteristics, so there's a tradeoff.
I have a crew cab short bed with a 32' fifth wheel and it doesn't feel big at all until I pull it on a forest service road in the woods. We plan on upgrading it anywhere from 2-4 years from now either with a toyhauler or another fifth wheel, but I really don't want to add much length if I can help it. I do plan on sticking with a fifth wheel type setup as I think the positives outweigh the negatives.