If they showed a true animal hoarder on the show there would be uproar. Real hoarding often involves the person getting tickets, if not outright arrested for animal cruelty.
The hoarding on the show is people harming themselves, and it's weird but whatever. But the hoarding situations that I know about locally are beyond what they would ever show.
The Chi hoarding case from California a few years ago that I was heavily involved with had dead dogs in crates that were decomposing, dogs eating the remains of other dogs, moms giving birth in the walls of the home, other dogs killing and eating the puppies... and worse. Over 100 inbred, feral dogs were taken out of that house. Can you imagine if a camera crew went in to that???? There is no way they could or would show that footage.