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My grandfather was the third in a line of men with the same first name, and middle names starting with the same initial. For example: George Floyd, George Frederick, George Francis. His son, my uncle, had the same name (i.e. George Francis). Even though they mainly had different middle names, they used name suffixes - Sr., Jr., III and IV.

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My uncle gave HIS son a name that only had the same initials (think Grant Forrest). I thought that was kind of a cop-out.

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That side of my family frequently used surnames from their family tree as middle names. This is actually really handy for genealogy. If there's no legal documentation on record for a couple, and the wife's name is Mary, good luck finding out which of a zillion Marys she was - unless they helpfully gave their son the middle name Herzberger or something.

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I'm a fan of using honoring names and maintaining name traditions, just because it gives a sense of continuity. I personally would use an honoring name after a beloved relative or friend, living or dead. If they were alive, I'd ask them first. If I didn't like the name, I'd put it in the middle. I also like the idea of using family surnames in the middle to sort of keep them alive.