I have reviewed recent studies that shed light on the paradox of insulin-induced ovarian hyperandrogenism in insulin-resistant states. Depending on the circumstances of the particular syndrome, insulin could act on the ovaries of insulin-resistant patients by activating IGF-I receptors, insulin receptors, hybrid insulin/IGF-I receptors, or any combination of these receptors. Further studies will uncover precise mechanisms of insulin-induced ovarian hyperstimulation in specific syndromes of insulin resistance.