Why are greetings so difficult?

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I read an old thread on greetings and it wasn't very conclusive, so I'm trying a new one, if that's okay: Why are greetings so difficult? I just can't seem to do them a lot of the time. I mean I've had daily training for 30+ years now (I mean life, not real training, though) and I still can't do them? Why? Can this be an autism thing in that my brain is simply too slow to get out the right sponateous greeting in time? Or is it because they feel fake? (This was suggested in the old thread by some) But then why am I okay with smalltalk but not with greetings? Anyone here has the same problem, maybe?

They feel fake to me. Unless it's an actual friend or relative, I really don't want to know how they are doing. I can and do say Hi or hello to strangers, but if they say it first I can't bring myself to ask how they are doing which is the expected response. I usually just return their greeting with Hi or if it seems more formal, Hello.

It is hard if you take things too literally.

For instance, it is better to use twenty than nineteen, or even better, two decades, even if you know it is precisely nineteen years. That sort of precision makes normals nervous.

I have a very hard time with greetings. I just call people by their first name.

I don't recall faces, so there is that.
But, I've gotten used to that so I just smile and say HI!

I'm not sure what you mean. Is it hard to say, "oh, hello" or "nice to see you" to someone before you start talking to them? It would seem much more awkward to just start talking about a particular subject without saying anything to lead into the conversation. If anything, I think the greeting is the easiest part because there is such a clear script.

I do get how some people can be annoyed about asking or being asked "how are you?" because it feels insincere. But I really do want to know how someone is. Especially if they are upset I don't want to start going on about something before first making sure it's okay and they're okay.