Snug is perfect in a neoprene dry suit.
I have a 7mm o'neil that fits much like a wet suit over lightweight undergarments (thin poly-pro fleece). I have dove it to 150' in 35 degree water and neither squeeze nor cold is a particular issue with the snug fit. What you will find is that a neoprene suit can be much snugger as the stretachable material still allows flexibility while the insulating properties of the neoprene itself means that thick lofted undergarments are not required.
In terms of squeeze, a trilam has sharper folds that seem to give a much sharper bite when the suit squeezes. In contrast a 7mm neoprene suit has a much softer squeeze so you can comfortably tolerate diving with much less gas in the suit. You could fully deflate a neoprene suit at the surface, then drop to about 50' before adding any air and not be excessively uncomfortable. I don't know many divers who would honestly say the same thing about a trilam.
The snug fit helps restrict gas flow in the suit so you can swim it in any position just like a wet suit yet even with minimal gas and a snug fit, the gas gets where it needs to be.
In short, after several years diving a neoprene dry suit, I'd argue most people end up with a neoprene dry suit that is too large and bulky as they approach sizing it like they would a trilam and they also tend to size upwards in anticipation of the heavier underwear that they would wear in a trilam that they will in fact ever need in a warmer neoprene suit.
The other observation I have is that 90% of the people who makes comments about neoprene dry suits have never used one and really don't know what they are talking about - they know what they heard from someone else (who usually heard it from someone else) or read in an ad, but they have no direct knowledge. I used to be one of those people and it took having to step out of my trilam and use a neoprene suit to correct the misperceptions created by the trilam only crowd.
The critical issue with a medium versus a large suit is probably going to be the boot size. Boots that are too small will cramp your feet and that makes for a miserable dive.