Ex-US Olympic gymnastics team doctor Larry Nassar has been sentenced to 40 to 175 years after testimony from nearly 160 of his victims.
The judge dismissed Nassar's attempted apology as insincere, saying he would "be in darkness the rest of his life".
Nassar pleaded guilty to 10 counts of sexual assault against girls and young women, including Olympians.
The 54-year-old had already been sentenced to 60 years for possession of child pornography.
Judge Rosemarie Aquilina told Nassar during the sentencing: "As much as it was my honour and privilege to hear the sister survivors, it was my honour and privilege to sentence you.
"Because, sir, you do not deserve to walk outside of a prison ever again."
She told the paedophile: "You have not owned yet what you did. I wouldn't send my dogs to you, sir.
"I've just signed your death warrant".
Following seven days of emotional testimony from Nassar's victims, he was given an opportunity to address the court.
"What I am feeling pales in comparison to the pain, trauma, and emotional destruction that all of you are feeling," he told the packed courtroom.
"There are no words to describe the depth and breadth of how sorry I am for what has occurred," he added.