This is one reason I never used it, but another reason is that I never felt that the privacy benefits were worth the hassle of randomized emails.

If I need to make an account with someone I don't trust enough to hand my email over to, usually the right answer is to just not create an account with them.

I have also tried things like having email aliases but what ends up happening is now I have more email accounts aliases to maintain/think about. It's annoying.

I don't personally find the prospect of "receiving spam email" or "having my email account leaked in a hack" to be particularly threatening. Spam just goes to the spam box, it's usually not my problem.

And besides, my real email can get exposed by my own legitimate companies that really should have my real email getting hacked. See also: EquiFax.