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Becuase its so very difficult to adjust the dose and control side effects. Say you get injected with 6 pellets and 6 weeks later your levels are too high - is the doctor going to cut into you to remove some of them? Or, say you are too low, is he going to inject more pellets? and, perhaps the most common issue is you get injected with pellets and your T levels are fine for, say 8 weeks, and then go too low, but your doc will only give you new pellets every 3 months - so you feel like sh*t for a month or two until your next dose.

Cutting edge TRT docs generally don't use pellets for all of these reasons. Twice weekly injections are easy to adjust, work great for like 95+% percent of guys and they are easier and cheaper for the patient as well.