I've used it with OpenSUSE, Fedora 37 and Debian 12, with only one extension: Rounded Corners. Although I did eventually install a different theme and icon set, just to make it look nicer as you can see from the screenshots I link above.
In fact, with the recent release of Debian 13, which uses the latest Gnome 48, I'm actually looking forward to giving it a try. There's been a lot of improvements.
The extension system could be much better. But I do like the idea of having a relatively simple system that is extensible, as opposed to having all of the options all at once, like in KDE. With Cosmic coming around soon, I think Gnome will have no option but to start working on improving this extension system to remain competitive.