PAM does not preclude having everything secure instead of some sort of 'hardened' bastion and 'soft' destination.
Everything should be 'hardened'. This also means everything has to do proper authentication and authorisation, and skipping that step by letting some proxy do that just creates a bottleneck in security, reliability, availability, and performance.
It also doesn't really matter how it's done, a Kerberos Ticket, x509 client certificate, JWT or multiple credentials (i.e. username with a password and MFA token) are all plenty valid. Granted, a ticket, certificate or token allows shipping claims or attributes allows for directory-less access control, but that doesn't mean that having to do directory lookups is not feasible anymore.
Most of the other things like f5, pa, Citrix, powerbroker and bomgar are just really shoddy software that you setup to attempt to not have to bear responsibility or know what you're doing (or it's clipboard/checklist-based security...), but that just bypasses fulfilling the actual need of a good IAM and PAM implementation. None of those products do it better than what is natively supported, and they are consistently more problematic (be it performance, cost or actual security).