Actually the stick isn't too large at all. Even I with my quite small hands mannage it very well. I pretty much never use the handrest, there is no need really. It does take some time getting used to though.
The CH setup (combatstick etc) are actually a bit larger and harder for people with small hands.
The TM HOTAS has tons of potentian but to really "be all it can be" some modding is needed for it, which I haven't been able to afford yet. The spring forces are nice when you move it either up and down or left and right BUT when you combine (say up right) the forces become twice as heavy which is anoying and makes fine aiming more difficult.
Perosnally I love the button layout, the Throttle is far superior to any other throttle I'd had my hands on, much thanks to the trim knobs but also thanks to the other buttons, they all feel as they are placed where they should be, not to mention the actual shape of the throttle. The stick feels the same more or less, once used to it, it feels great.
HOWEVER I would not recomend it for AH as, the stick forces are too heavy in its stock version. It makes gunnery a bit more difficult.
As it is now I use the throttle (can't live without it) and a Sindewinder PS Pro 2 stick for AH, all other games I use the Cougar!