Students with math and physics backgrounds are fine with Greek letters and other mathematical symbols, but the biologists in the class are mystified. They also get terribly confused when I reuse symbols for different purposes.
What I've discovered is that the students who have trouble with mathematical notation and reasoning got derailed when a teacher, in an early grade, said "let x be the unknown". That is a phrase that never comes up in other contexts, and I think it throws them off track. Many find it difficult to get back on-track later, so they memorize and sleep-walk their way through other mathematics classes until the system no longer insists that they take them. A shame, really.