Nah, I'm running the ASRock Z390 Phantom Gaming ITX motherboard in my system.
This is correct, but I did have to sand down part of my NF-A12x15 fan to clear the VRM heatsink from my motherboard. Images of the mod here and here.
The non-recommended orientation barely effects temps, as I tested this a while back and posted here.
I just upgraded to the 9900K and OCed to 4.8ghz all core (modest I know), and it only hit 84C on synthetic bench runs. Don't let silly orientation "rules" keep you from using a fantastic cooler. Would it be better if it was turned sideways allowing the top fans to pull air through the fin array? Yes. Does it still cool well in the "worst" orientation for it? Yes.
It seems you have had a different experience from what has been reported here:
"Initially installed the cooler with the heat pipes facing down, but upon realizing this was not recommended by noctua, I tried altarnative orientations.
Unfortunately my mobo (Aorus B550i) has the CPU socket quite high in the PCB, so the only way for it to fit was by removing the side bracket keeping only the fan rail.
It was a really tight fit, but I have seen tempartures drop ~5ºC when under load (Ryzen 5 3600)."