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Works that way for me, as long as I am the host.
The option is NOT in the dropdown for "Mild" "medium" and "whoa", it's above that, at the very top of game settings. It's Just text that says "Change to custom" or something of that nature. You click it, and it will ask if you are sure you want to.
Edit to add:
Here, I took to some screenshots to show what to do:
https://steamcommunity.com/sharedfiles/filedetails/?id=2870978718
https://steamcommunity.com/sharedfiles/filedetails/?id=2870978726
That setting still has an impact on a custom game. Namely all of these variables depend on it:
Hunger and Thirst:
Mild: 1/2 baseline rate
Medium: Baseline
Whoa: Degrade 1.5 times baseline
Player Damage:
Mild: 1.25 times baseline
Medium: Baseline
Whoa: 75% of baseline damage
Enemy Damage:
Mild: 1/2 baseline damage
Medium: Baseline
Whoa: 1.5 times baseline damage
Building Health:
Mild: Double baseline
Medium: Baseline
Whoa: Half baseline health
Heat Multiplier:
Mild: Half
Medium: Baseline
Whoa: Double
Spoilage:
Mild: 1/2 as fast as Baseline
Medium: Baseline
Whoa: Twice as fast as baseline
Item Durability:
Mild: Double baseline
Medium: Baseline
Whoa: 75% of baseline
Durability Loss on Death:
Mild: None
Medium: 5%
Whoa: 10%