INSR and hyperinsulinism: At age 29 with hyperinsulinemia and testosterone in the adult male range with INSR autoantibodies. Spontaneous remission of autoantibody with resolution of hyperandrogenemia. Autoantibody recurred 2 years later, manifesting as hyperglycemia, worsening acanthosis, voice changes, and increased shaving. Treatment with leuprorelin led to normalization of serum testosterone, despite persistent extreme insulin resistance, with decreased frequency of shaving, improved acne, softer voice, and better mood.