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So it has support for hearing aids. But nothing for the automotive side of things in that regard for the hard of hearing. His phone was connected to the car via Bluetooth. But no sound was coming from the cars speakers, and that sound was not transmitted to his hearing aid.
The onscreen toggle setting for Google maps does not show up until you select to navigate to a destination (this was a problem, because at first we couldn't even see if it was toggled on). Picking a destination and choosing to start navigation made that toggle show up, and it was toggled on but we still had no sound.
There's a settings toggle at the bottom of his screen (mine is not the same, I checked that both apps are updated to the latest firmware), and that settings menu has toggles for things like assistant voice/smart features related to the app, but no sound features. To get to the advanced sound features for the app you have to select your profile from the menu, then select settings, then select Navigation settings, and only then can you select things like "mute state", or "guidance volume".
Specifically things like "play voice over Bluetooth" which was not selected by default after his last update. This is not a setting he even knew existed or knew how to find. So I honestly doubt he deselected it.
My pixel 8 has accessibility features that allow for quick toggles. To control things like screen brightness and volume. It also has more settings for the hard of hearing than his. His S23 has the support for hearing aids but not things like sound amplifier that I was looking for. And audio adjustment which would have been useful to allow him to rebalance the sound for the ear that doesn't use a hearing aid. I actually wonder if that's a developer settings thing and why it should be hidden that way.
I also couldn't select what type of Bluetooth device he was using (but this may be because of the make and model of his car, not a shortcoming of Google or Android).
For him I'm sure this was very confusing because it seemed convoluted even to me. Anyway in the long run, we got voice prompts for navigation up and running, and he was happy with that. But the bar for entry for the hearing impaired seems a bit high.