I recently traded my 6sp HO 2001 in for a new HO/48RE 03 because I was tired of shifting. I was concerned about the automatic, since I thoroughly roasted the transmission in my '96 (whatever it was).
I took my first trip this past Weds and got home today. I had my 2000 Lance 1030 camper on the truck (4500 lbs by itself) and was towing a quad on a flat trailer, maybe 1500 lbs more.
In a nutshell, I was thoroughly impressed with the new transmission. Only once did it have to downshift going up a hill, and that was because I started at too low of a speed anyway. Whenever I had the cruise set at or above 68 mph (speed limit was 70 anyway), it held just fine. It would lose up to 5 mph on some of the steeper hills, but I expected that at the 4500-6000' elevations where I drive, on a truck with about 1400 miles on it.
What I really enjoyed was the couple of times when I was following a friend in his 02 F350 PSD auto, towing two quads on a larger flatbed (probably 3000-3200 lbs) and he would slow down on hills much more than I would... and he generally went faster on the flats than I wanted to, so it wasn't like he wasn't putting his foot in it.
Rob