At age 16 with primary amenorrhea, clitoromegaly and facial hirsutism requiring shaving. Ferriman–Gallwey score 14, Tanner III breast development, Tanner IV pubic hair, clitoral index 105 mm2 (normal <35mm2). Multiple small ovarian follicles but no large cysts on pelvic ultrasound. 11.25mg leuprorelin acetate depot injections initiated 8-weekly with COCP. Reduction in testosterone and clitoral index over 4 months, without reported changes in mood, libido or shaving frequency. Insulin sensitivity did not change. Here, INS is linked to Primary amenorrhea.