"Since most 3-railers are not concerned with realism below the belt rail"
Completely untrue.
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I upgrade (yes) 2-rail rolling stock to 3-rail regularly; I am quite concerned with how it looks below the waist, as any Hi-Railer would be, especially one who has reached the brass-car-to-3-rail conversion project level. Mine sit low, but you have to do it right. And it is on a case-by-case basis.
I do not mind dummy couplers, so I often put hi-rail wheelsets in the original "2-rail" trucks (typically not too difficult; sometimes not worth it), remove the scale or Kadee (not the same thing) couplers and just mount a Keil-Line Hi-rail coupler in the same spot, even in the same box with the same screw in the case of replacing a scale dummy coupler.
The new low-bolster trucks from L and M and A sit so nice and low that I have had to shim them up here and there on old stuff.
Depending on how much you want to mess with the old car, even older high-bolster 3-rail trucks will work fine if you remove some/all of the car bolster (a typically invisible change from operating view). I did a couple of Intermountain reefers that way.
Pardon the poor cropped photo below; I don't have a good shot of one of my "dummy" projects, and it is not finished. The coupler will be positioned a bit farther in (just a hole and a screw) and painted brown; the car came painted gray - perfect for some GM&O hoppers.
The car? It's so old that it is Japanese (no Korean or Chinese model RR equipment then), all brass, Max Gray, and still has the original "scale" (yeah, right - it's often just the wheels) trucks - now with Hi-Rail Weaver wheel sets.