'05 V-10 4X4 EXcursion here at 101k miles with 4.88 gears and 35" tires on a 4" lift, the tire/gear combo nets an effective ratio of 4.39. It has Banks headers and custom tunes by 5Star Tuning, I use the 87 Performance tune for most all of my towing miles. Suspension is upgraded to F-350 springs (plus an extra leaf on the front and 2 extra leaves on the rear) and has a Hellwig rear sway bar (anti-roll bar) and Rancho RS9000XL adjustable shocks. Trailer is a 2014 Jayco Eagle Premier 338RETS 41' hitch to bumper at 11k lbs loaded for travel, hitched via a Hensley Arrow. Tows great, every bit as well as a STOCK 7.3. The 4R100 trans is a solid performer if it's well maintained and the temperature is monitored, I still run the stock trans cooler and the highest temp I have seen was 204F for a minute or two climbing a steep grade from a stop in VT last Summer. We have pulled those WV, VA, KY, TN and PA hills along with New England's mountains without issue. Current configuration has returned consistent 8.5 to 9 towing MPGs with a best of 9.26 from RI back to Philly. For the big hills yes it will drop a gear or two like the others have said but the V-10 likes to rev. The deeper gears, headers and tunes combine to make good enough power and trans control to stay in OD much more than stock, helping to stretch the mileage nicely. We have made the pull from Savannah GA back home to Philly via I-95 without dropping out of OD a single time on the highway running at 60 to 65 MPH.