Disgraced long-time USA Gymnastics team doctor Larry Nassar was sentenced on Wednesday to 40 to 175 years in prison for molesting young female gymnasts, following days of wrenching testimony from about 160 of his victims, including Olympic medalists.

“I’ve just signed your death warrant,”

Ingham County Circuit Court Judge Rosemarie Aquilina said as she announced Nassar’s sentence and delivered a searing rebuke of his years as an abuser.

Aquilina also scoffed at the apology Nassar offered his victims and said he will be required to make restitution to them.

Some victims dabbed their eyes after Aquilina spoke, while Rachael Denhollander, the first woman to come forward publicly in 2016, smiled. Spectators applauded when the hearing ended and Nassar, wearing a dark blue jail house jumpsuit, was led out of the court.

Nassar, 54, pleaded guilty in November to seven counts of first-degree sex assault in Ingham County, as well as three additional charges in Eaton County, where he will be sentenced next week. He is already serving a 60-year sentence in federal prison for child pornography convictions.

Nassar, who served as the USA Gymnastics physician through four Olympic Games, apologized to his victims before the sentencing, telling them, “I will carry your words with me for the rest of my days.”

But Aquilina dismissed his statement as insincere, reading aloud from a letter he wrote to her in which he claimed he was a good doctor who was “manipulated” into pleading guilty, drawing gasps from courtroom spectators. Nassar also claimed his accusers fabricated claims to gain money and fame and wrote, “Hell hath no fury like a woman scorned.”