LANSING, Mich. — The former sports doctor who admitted molesting some of the nation's top gymnasts for years under the guise of medical treatment was sentenced Wednesday to 40 to 175 years in prison by a judge who proudly told him, "I just signed your death warrant."

The sentence capped a remarkable seven-day hearing in which more than 150 women and girls offered statements about being abused by Larry Nassar, a physician who was renowned for treating athletes at the sport's highest levels. Many confronted him face to face in the Michigan courtroom.

"It is my honor and privilege to sentence you. You do not deserve to walk outside a prison ever again. You have done nothing to control those urges and anywhere you walk, destruction will occur to those most vulnerable," Judge Rosemarie Aquilina said.

Nassar's actions were "precise, calculated, manipulative, devious, despicable," she said.

When the hearing ended, the courtroom broke into applause. Victims and prosecutors embraced at the conclusion of the grueling 16-month case.

But the anguish of the past week will have little, if any, practical effect on Nassar's fate. Before serving the Michigan sentence, the 54-year-old must first serve a 60-year federal sentence for child pornography crimes. With credit for good behavior, he could complete that sentence in about 55 years. By then, he would be more than 100 years old if still alive.

He is also scheduled to be sentenced next week on more assault convictions in Eaton County, Michigan.

A prosecutor called Nassar "possibly the most prolific serial child sex abuser in history" and said competitive gymnastics provided the "perfect place" for his crimes because victims saw him as a "god."

Prosecutor Angela Povilaitis also said Nassar "perfected a built-in excuse and defense" as a doctor, even though he was "performing hocus-pocus medicine."

"It takes some kind of sick perversion to not only assault a child but to do so with her parent in the room, to do so while a lineup of eager young gymnasts waited," Povilaitis said.

She urged people to believe young victims of sexual abuse no matter who they accuse and praised journalists, including those at the Indianapolis Star. The newspaper's 2016 investigation of how the sport's governing body handled sexual abuse allegations against coaches prompted a former gymnast to alert the paper to Nassar.

Although Nassar's work with gymnasts received the most attention, the allegations against him spanned more than a dozen sports over 25 years.

At one point, Nassar turned to the courtroom gallery to make a brief statement, saying that the victims' accounts had "shaken me to my core." He said "no words" can describe how sorry he is.

"I will carry your words with me for the rest of my days" he said as many of his accusers wept.

The judge then read from a letter that Nassar had written to her that raised questions about whether he was truly remorseful. The victims who packed the courtroom gasped as they heard passages that included "Hell hath no fury like a woman scorned" and another in which Nassar said the "stories" about him were fabricated.

He also defended his actions with the athletes as "medical, not sexual."

"I was a good doctor because my treatment worked, and those patients that are now speaking out were the same ones that praised and came back over and over, and referred family and friends to see me," Nassar wrote.

One of the first athletes to publicly accuse Nassar of sexual assault was the last victim to offer a statement at the hearing.

Rachael Denhollander is a Kentucky lawyer who stepped forward in 2016 after the sport's governing body, USA Gymnastics, was accused of mishandling sexual assault complaints. She said Nassar groped and fondled her when she was a 15-year-old gymnast in Michigan.

Denhollander's statements to Michigan State University police put the criminal investigation in high gear in 2016.

"You have become a man ruled by selfish and perverted desires," she told Nassar, who worked at the university and USA Gymnastics, which also trains Olympians.

Hours after the sentencing, MSU President Lou Anna Simon said she was resigning amid mounting pressure over the way the university handled the Nassar case. That came shortly after Michigan lawmakers voted overwhelmingly for a nonbinding House resolution that sought her removal over allegations that the school missed chances to stop Nassar.

In her resignation letter, Simon said as tragedies are politicized, blame is inevitable. She acknowledged she was a natural focus of the anger as president.

Simon, who earned her doctorate at Michigan State in 1974, was promoted to school president in 2005.

Nassar pleaded guilty to assaulting seven people in the Lansing area, including in the basement of his home and at his campus office. But the sentencing hearing was open to anyone who said they were a victim.

Accusers said he would use his ungloved hands to penetrate them, often without explanation, while they were on a table seeking help for various injuries.

The accusers, many of whom were children, said they trusted Nassar and were in denial about what was happening or were afraid to speak up. He sometimes used a sheet or his body to block the view of any parent in the room.

Several elite former gymnasts talked about how Nassar won their allegiance with candy, Olympic trinkets and encouraging words while they were under constant scrutiny from demanding coaches.

The judge praised the victims who appeared in her court, calling them "sister survivors." The women included Olympians Aly Raisman, Jordyn Wieber and McKayla Maroney.

The judge also called for a broader investigation into how the abuse was allowed to go on for so long. She said justice "requires more" than what she can do.

The CEO of the U.S. Olympic Committee soon announced an independent inquiry. Scott Blackmun said the third-party investigation will attempt to determine "who knew what and when."

Brooke Hylek, a gymnast who plans to compete in college, heaped scorn on Nassar.

"I cannot believe I ever trusted you, and I will never forgive you," she said Tuesday. "I'm happy you will be spending the rest of your life in prison. Enjoy hell by the way."

Excerpts of some victims' statements

Almost 160 women and girls have come forward in a Michigan courtroom to confront Larry Nassar, the former gymnastics doctor who molested them under the guise of medical treatment.

The victims made their statements during an extraordinary sentencing hearing for Nassar, who has admitted sexually assaulting athletes while employed by Michigan State University and USA Gymnastics, the sport's governing body. Here are excerpts of some victims' statements over the last week.

--------

The first victim to speak was Kyle Stephens, who said Nassar repeatedly abused her from age 6 until age 12 during family visits to his home in Holt, Michigan.

"I testified to let the world know that you are a repulsive liar and those 'treatments' were pathetically veiled sexual abuse," she said. "Perhaps you have figured it out by now, but little girls don't stay little forever. They grow into strong women that return to destroy your world."

------

A 2000 Olympian, Jamie Dantzscher, looked at Nassar as she said: "How dare you ask any of us for forgiveness."

"Your days of manipulation are over," she added. "We have a voice. We have the power now."

--------

Clasina Syrovy, who competed as a gymnast for 15 years, fought back tears as she confronted him.

"Larry, how many of us are there? Do you even know?" she said. "You preyed on me, on us. You saw a way to take advantage of your position — the almighty and trusted gymnastics doctor. Shame on you, Larry. Shame on you."

Syrovy said speaking up will allow her to move forward.

"After today, I will not cry anymore," she told Nassar. "I am done. ... You are a disaster."

--------

Physical therapist and former gymnast Marta Stern spoke on the fifth day of the hearing, saying she originally wanted to remain anonymous "out of fear of how it would affect my life, my loved ones and my career."

"However, I will no longer let you have control over me. I will not let you win," she told Nassar.

--------

Melissa Imrie said she was assaulted in 1997, when she was 12, after breaking her tailbone. She described the severe depression, sleeplessness and other issues that plagued her for years.

"Everybody's story that I listened to today is just an echo of everything that I've went through. They're just speaking like it's my voice."

She said she wants young athletes "to be safe from sexual predators, from this kind of abuse."

--------

Olympic gold medalist Aly Raisman initially said she wouldn't attend the hearing because it would be too traumatic, but the 23-year-old later showed up in court and spoke directly to Nassar.

"You have not taken gymnastics away from me. I love this sport, and that love is stronger than the evil that resides in you, in those who enabled you to hurt many people," Raisman said.

--------

Emma Ann Miller, 15, said Michigan State University was still billing her mother for medical appointments in which Nassar molested Miller as recently as August 2016 — a week before he was fired.

In her statement to the court, Miller directly addressed Michigan State.

"I, like all those that have spoken, didn't choose this circumstance to have the right to be standing in front of this podium today. Nassar made that choice for us — your 20-year child-molesting employee."

--------

Former gymnast Lindsey Lemke, 22, was among the victims criticizing USA Gymnastics and Michigan State University President Lou Anna Simon. The school is being sued by dozens of women who say campus officials wrote off complaints about Nassar.

Referring to Simon, she said: "Guess what? You're a coward, too."

And to Nassar: "You sit up here shake your head back and forth. You abused us and you don't even remember. That's sickening."

Lemke listened as her mother, Cristy Lemke-Akeo, also gave a statement in which she described Nassar as a family friend who was "someone we completely trusted." Nassar "ultimately abused her on a daily basis for many years, starting around the age of 10," her mother said.

--------

Marion Siebert described the ordeal that victims like herself will face going forward.

"Every time someone Googles them, for the rest of their lives, they will see the sickening things we're talking about here today. When they apply for a job, when they go on a first date, they won't be able to be the ones to fully make the choice on when to talk about what happened. This terrible part of their past is exposed to all."

--------

Sisters Maddie and Kara Johnson both gave statements about being abused by Nassar.

"He was the doctor. I was the child. I had no idea what to think," Maddie Johnson said. "For the longest time, you deprived me of my happiness. Because of you, every time I hear someone call me, 'Kiddo,' I think of the face you made when you were abusing me."

Her sister said: "I will never be able to get back what you have so effortlessly taken. ... After this is all over, I can finally be a senior in high school again."

------

Oklahoma gymnast Maggie Nichols' mother read her statement. Gina Nichols said it would be too painful for her 20-year-old daughter to attend the hearing. The young woman went to Nassar for treatment of back pain when she was 15.

"I remember he took me into the training room, closed the door and closed the blinds. At the time I thought this was kind of weird but figured it must be OK. I trusted what he was doing at first, but then he started touching me in places I really didn't think he should.

"He didn't have gloves on and he didn't tell me what he was doing. There was no one else in the room and I accepted what he was doing because I was told by adults that he was the best doctor and he could help relieve my pain."

--------

Nicole Reeb said she sought treatment from Nassar, hoping that he would help her compete as a dancer in high school and college.

"I have spent my entire adult life crawling my way through the aftermath of being sexually abused."

--------

Gymnast Katie Rasmussen said she was abused when she went to Nassar for treatment of a hamstring injury.

"No one did anything because no one believed me. They didn't understand how such a respectable doctor would do something like that. And I don't understand how a 14-year-old could make that up."

--------

Alexis Alvarado said she was abused by Nassar in her first session with him when she was 12. In her statement, she referenced statements Nassar made in a letter to Judge Rosemarie Aquilina that were critical of her handling of the case.

"This is not Judge Aquilina's so-called 'circus' that you called it. This is your hell. And I hope you burn in it."

--------

Arianna Guerrero, 16, is a high school gymnast in Michigan. She went to Nassar after experiencing back pain.

"You, Larry, turned the sport I love into the sport I hate. I hope someone does to you what you did to us for the rest of your life."

--------

Jessica Thomashaw, 17, recounted how she was sexually assaulted at ages 9 and 12.

"He touched the most innocent places on my body. I couldn't be just a normal girl anymore, and I forever lost a big piece of my childhood due to his abuse."

--------

Olympic gold medalist Jordyn Wieber made a surprise appearance in court and, like many of the victims, allowed her name to be used publicly.

"Even though I'm a victim, I do not and will not live my life as one. I'm an Olympian despite being abused. I worked hard and managed to achieve my goal."

------

McKayla Maroney, a 2012 Olympic gold and silver medalist, had a statement read in court in which she said being sexually assaulted by Nassar scarred her mind in ways that may never heal.

"Dr. Nassar was not a doctor," she wrote. "He left scars on my psyche that may never go away."

--------

Former gymnast Jeanette Antolin was a member of the national team in the late 1990s when she went to Nassar for treatment.

"He robbed a good portion of my gymnastics experience, not just from me, but from countless women. Only a monster would harm innocent children the way Larry did. I will never understand the evil that motivates an adult to abuse an innocent child," she said.

--------

Gymnast Melissa Imrie said she was sexually abused when she went to Nassar in 1997, when she was 12, for treatment of a fractured tailbone.

"On the way home, I told (my mom) what happened — she was livid, so furious."

--------

Soccer player and gymnast Christine Harrison said she saw Nassar when she was 15 and 16.

"I know the truth. Regardless if he remembers what he did to me or not, I remember. That's all that matters. You knew what you were doing was wrong. It wasn't until you got caught that you started to beg for forgiveness."

She said she saw Nassar for injuries.

"My family always used the saying, 'The Lord helps those who help themselves.' But with you, you had the opportunity for years to seek help. You knew what you were doing was wrong, but it wasn't until you got caught that you started to ask for forgiveness."

--------

Olivia Cowan said she saw Nassar more than 10 years ago.

"The anxiety this has caused me is what leaves me feeling like there's nothing more to give. There's not a day that passes that I don't think about the monster."

--------

Melody Posthuma-Vanderveen said she was first abused by Nassar when she was 13 years old.

"I'm still suffering every day and will continue to do so. And I ask each one of you — and everyone this reaches — that you will help cultivate environments where women don't have to live in fear. I wholeheartedly believe that this begins with giving you a life sentence today."

------

Associated Press Writer Ed White in Detroit contributed to this report. AP Sports Writer Larry Lage in East Lansing also contributed.