Almost no one actually needs a full-size pickup. The only real exception is if you regularly haul heavy loads on trailers, but that doesn’t apply to most full-size pickup owners. Most people buy them because it’s part of an image they’ve been sold through the advertising industry.
I drive a 20-year-old mid-sized pickup with an extended bed and there has never been a single time when it hasn’t been perfectly adequate for all my needs. It’s also a 4-wheel-drive, but since I only ever use that feature on snow and ice and rough unpaved roads and am not an off-road enthusiast, it’s not lifted and doesn’t tower over other vehicles in traffic.