Pre-symbolic algebra has been advocated for as a mathematics topic elementary students should experience to better prepare them for middle and high school algebra. However, most elementary pre-service teachers have little to no experience with pre-symbolic algebra. The study reported here analysed the struggles that ten elementary pre-service teachers experienced when learning about pre-symbolic algebra in a mathematics content course. Three types of struggles emerged, struggles with changes in the artefacts of algebra, the objects of algebra, and pre-service teachers' role while doing algebra. This study could inform efforts to better support elementary PSTs in preparing to teach pre-symbolic algebra.