LANSING, Mich. -- Larry Nassar was sentenced to 40 to 175 years in prison on Wednesday after seven days of impact statements from more than 150 girls and women who said he sexually abused them. The former USA Gymnastics and Michigan State doctor, who hung his head and cried periodically during the sentencing hearing, told the courtroom he would carry his victims' words with him "for the rest of my days."
Judge Rosemarie Aquilina said Nassar's "decision to assault was precise, calculated, manipulative, devious, despicable."
"It is my honor and privilege to sentence you. You do not deserve to walk outside a prison ever again," she said. "You have done nothing to control those urges, and anywhere you walk, destruction will occur to those most vulnerable."
Aquilina added: "I just signed your death warrant."
Nassar, 54, received a 60-year federal prison sentence in December for child pornography charges.
He gave a statement before his sentencing on Wednesday, turning at times to address the courtroom gallery.
"Your words these past several days have had a significant emotional effect on myself," he said. "I will carry your words with me for the rest of my days."
Prosecutor Angela Povilaitis had asked Aquilina to sentence Nassar to up to 125 years -- one year for every person who had submitted a police report at the time of his guilty plea.
Nassar's minimum sentence is 40 years, and it will be served after his federal sentence expires. The maximum sentence of 175 years stays within the sentencing guidelines. Nassar will get credit for time served for the past year. He will first be eligible for parole in 99 years -- in 2117.
Though Nassar apologized during his statement, Aquilina read sections of a letter he submitted to the court last week in which he maintains that what he did was medical and not sexual in nature. He wrote that media reports sensationalized the stories about his abuse and that he was forced to admit that they were sexual in nature in order to get a plea deal.
"I was a good doctor," he wrote.
Aquilina asked if he wanted to withdraw his plea, and Nassar said he did not. She asked: "You are guilty, aren't you?" He paused before saying that he stood by his plea.
Nassar pleaded guilty to 10 counts of first-degree criminal sexual conduct in November. This week's hearing was for seven of those charges, which occurred in Ingham County, where Michigan State is located. Next week, Nassar will be sentenced for the three others in nearby Eaton County, where he lived and saw patients at Twistars Gymnastics.
A total of 156 people, which included women, girls and their parents, provided impact statements during seven days of the sentencing hearing in Lansing. Roughly two dozen more submitted written statements that weren't read aloud in court. Along with recounting their experiences with Nassar and telling him that they planned to take their power back from him, many who gave statements criticized Michigan State and USA Gymnastics for ignoring complaints about the disgraced doctor for nearly two decades.
"These have been important narratives to hear and witness and listen to," Povilaitis said on Wednesday. "They will be the words that burn down cultural stereotypes and cultural myths. ... [Nassar] is possibly the most prolific child abuser in history."
Aquilina spoke harshly about Nassar throughout the weeklong sentencing hearing, at one point telling him that if cruel and unusual punishment was allowable she would have others abuse him in the same way he abused his victims.
On Wednesday, Rachael Denhollander, a 32-year-old attorney and mother of three who in September 2016 was the first woman to publicly accuse Nassar of sexual assault, delivered the final impact statement. Many of the people who went before her cited Denhollander's bravery in coming forward as the reason why they appeared in court this week. She asked Aquilina and the court repeatedly: "What is a little girl worth?"
Denhollander detailed her path to the Lansing courtroom, which included law school and meticulously compiling a file so police would take her claims seriously before she filed the first report in the case more than a year ago. She criticized Michigan State for long ignoring calls for help about Nassar and for the response from the university's leaders since her accusations became public. She said she pities Nassar for losing the ability to determine between good and evil.
"You could have had everything you pretended to be," she said. "Every woman who stood up here truly loved you as a child -- real, genuine love."
Attorneys met in Grand Rapids, Michigan, on Wednesday morning to discuss the timeline of a civil suit against Nassar, Michigan State, USA Gymnastics and several individuals from both institutions, which is expected to begin when Nassar's hearings are complete. Michigan's attorney general also plans to review the case to determine if anyone else who enabled Nassar during the past quarter-century should be held criminally accountable for their actions.
Denhollander called Wednesday's sentence a victory. Her message for the future: "Do it better next time."
The Associated Press contributed to this report.