Yes, much more balanced gameplay than FO3 and food and drink items actually have some purpose. In FO3 they were simply extra junk to weight you down.
I didn't truly get the full enjoyment out of hardcoe mode until I downloaded and installed the Harder hardcoe Rates (Refined Rates) mod from newvegasnexus.com
http://www.newvegasnexus.com/downloads/file.php?id=36432
The problem with vanilla hardcoe mode is that there is simply too much food and water everywhere and you don't need to sleep very much, only once every several days.
The Harder hardcoe rates mod does not make the gameplay more realistic, but it makes it much more balanced and fun, because after installing it, I would sometimes actually run out of water, or go into advance sleep deprivation because there were no beds or faucets anywhere near the area where I was. Lots more fun and makes you actually have a reason to care about finding food and water. Big improvement over vanilla hardcoe.
2. would you do it again?
Absolutely, I will never play FNV on "non-hardcoe" mode. it seems quite boring after enjoying hardcoe for 160 hrs on my first playthrough (not finished yet).
3. what difficulty did you use?
Very Hard. I would not enjoy any other setting. Even very hard is not difficult enough. With melee build using super slam perk, you can easily wipe out most enemies.
4. are there things you wish you knew before you started?
When playing Caravan after the mini-game starts you have to move your cursor to move the cards around to different positions so the card changes from Red to Green before you can place the card in your stack correctly. This was not included in any of the instructions or tutorials I read, and I lost several games before figuring this part out.
5. if you did it over again you would ____________
probably make the same choices, but make sure not to go over 80 lockpick even with all the skill books, because with a skill magazine you can get +20 in order to pick any very hard lock.
also I would not waste any perks at all with Intense Training
6. did you primarily go for the end game or did you do a lot of exploring and questing?
After 160 hours I'm just starting to get into the key events of the main quest.
From the start of the game, I just walked off into the desert and began exploring the wasteland and doing side quests. I deliberately put off the main quest as long as possible.
7. did you vat a lot more than a normal game?
I only use VATS rarely, but in FO3 after several playthroughs, I stopped using VATS entirely because the game is a bit too easy. Also VATS mode in FO3 makes you invincible which is kind of boring.
8. were any skills or attributes more important in the HC game than a normal game?
Survival is important. Definitely get at least 70 survival so you can get Rad Child. Rad Child and Super Slam are the two most powerful perks in this game. If you stay at Deadly or Critical Rad Poisoning level you will constantly regen +8HP/sec or +6HP/sec.
Remember, if you get the Comprehension perk and find all the skill books you get +20 science and +16 for all the other skills. Also, there are many many skill magazines that provide a temporary +20 boost with Comprehension, so never go above 80 science, 80 lockpick or 20 below the highest speech check you want to pass (for example, the highest one I found is 75 in order to convince Arcade Gannon to join you, so you would only need 55 speech plus Meeting People magazine to pass - actually for Speech it should be even less than 55 because you can wear Benny's suit, Naughty Nightwear and take Party Time Mentats for extra boost to pass tough speech checks).
Pick either speech or barter but don't put points into both. Every conversation that has a barter dialogue check also seems to have a speech check. no need for both. I am almost finishing the game with Barter only 11 after 160 hrs and I have had no trouble at all. there are more than enough caps in the game from gambling, looting, playing caravan etc. (In fact, I installed the Expensive Wasteland mod which makes everything 10x more expensive when you buy from merchants and I still have more than enough caps and don't need Barter skill).
In FO3 it was very easy to max out or come close to maxing out all of your skills. In FNV not only is it not necessary to max everything out, but you are missing the point of role playing and specializing in certain things. Just make sure to check the requirements for the perks you want to get. For example, Jury Rigging (requires Repair 90), Piercing Strike (requires unarmed 70), Rad Child (requires Survival 70), Super Slam (requires melee 45).
Also, Luck is very, very important. I would suggest starting with Luck 10 from Doc Mitchell's house. This saves you an implant slot later and also results in almost every hit being a critical hit. With luck 10 you don't need the Finesse perk because you already have so many critical hits.
Endurance start with at least 5 or 6 and you will have 5 or 6 implant slots. END implant is a neutral cost, because it gives you one more implant slot. also it helps counteract the effects of Deadly/Critical Rad poisoning from the Rad Child perk, so definitely worth it. Also you need minimum END 6 in order to get Stonewall, which is one of the best perks (it provides constant +5 DT vs. melee attacks)
Charisma is not necessary at all. It only helps your companions DT, doesn't help you at all. CHA implant is not worth it, don't get it. Get Sub-Dermal Implant instead.
Str 5 or 6 or if you want to focus on melee, then 7 or 8. Str implant is worth it to help you carry more.
Per 5 so you can get Better Criticals after getting the PER implant.
Agility 4 or 5 unless you want a guns/sniper/VATS character, in which case I would go with AGI 7 or 8 and STR 5 or 6. Agility implant is worth it if you use VATS a lot or want to increase your guns.
Int 7 or 8, plus implant.
Sub-dermal implant is very good.
Monocyte Breeder Implant is a complete waste of caps and implant slot. It's completely useless in combat. Only +1HP every ten seconds. Rad Child perk is 60-80 times more effective (constant +6HP/sec or +8HP/sec regeneration depending on whether you are at deadly or critical rad poisoning level) and actually makes quite a difference during combat.
9. did you use companions? if so who?
Cass provides the greatest perk, by constantly drinking whiskey, you can have constant +2STR and +4 DT to as high as +6 DT (depending on your Survival skill). This is equivalent to getting three different implants, or a few ranks of the Intense Training perk. ED-E's perk is the next best.
However, since companions die on hardcoe, I only travel with the companions in order to complete their quests.
I keep them all stationed waiting in the area where I first found them.
It's also a bit boring to enter into combat with companions at your side because not only are they likely to rush forward and get themselves killed, but more often than not the enemies are not too difficult, in which case they wipe out the enemies before you have a chance to do anything. If the fight is challenging then your companion will quickly die. Better to leave them at home and just benefit from their perk.