Disgraced Olympics doctor Larry Nassar has been sentenced to up to 175 years for sexually abusing young gymnasts in his care.
As she read his sentence on Wednesday, Judge Rosemarie Aquilina said Nassar's decision to assault was "precise, calculated, manipulative, devious and despicable".
She told him: "It is my honour and privilege to sentence you. You do not deserve to walk outside a prison ever again... I've just signed your death warrant."
The decision follows more than 150 victim impact statements from women and girls who told the court they had been sexually assaulted by Nassar.
Among them was Olympic medal winner Aly Raisman, who said he "should have been locked up a long, long time ago".
"We have no idea how many people you victimised, or what was done, or not done, that allowed you to keep doing it, and to get away with it for so long," she said.
Prosecutor Angela Povilaitis described the "breadth and ripple" of Nassar's crimes as "nearly infinite".
The former sports doctor has pleaded guilty to sexually assaulting seven females between 1998 and 2015, and also has a 60-year prison sentence for child pornography charges.
Before his sentencing, he told the courtroom that victim testimonies had "shaken me to my core", and said: "I will carry your words with me for the rest of my days."
But Judge Aquilina dismissed the statement, reading from a letter in which Nassar argued he had been "manipulated" into a guilty plea and claimed victim's stories had been "fabricated" to "sensationalise" the case.
Those in the courtroom gasped as they heard Nassar had wrote he was living a "complete nightmare" and that "hell hath no fury like a woman scorned".
Judge Aquilina told him: "This letter tells me you still do not own what you did. I wouldn't send my dogs to you, sir."
In an extraordinary and emotional week of testimony at the court in Lansing, Michigan, survivors described chilling details of abuse at the hands of Nassar.
A respected medical doctor trusted by young women in a high-pressure environment, he molested girls while purporting to give them medical treatments, sometimes in the same room as parents and other gymnasts.
Many addressed Nassar with defiance, urging the judge to give a maximum sentence while recalling years of struggling with shame and silence.
"He did this with my own mother in the room," said former gymnast Rachael Denhollander, who was the first woman to come forward with allegations against Nassar.
"I assured myself it must be fine because I could trust the adults around me."