Is it permissible to perform a sex-change operation for someone who was raised as a female for 25 years but was medically determined to be male, and is it permissible for him to remain in his state as a male living a female life without an operation, and what is the ruling on this suffering?

For someone whose male gender has been medically confirmed, it is not permissible for him to transition to female, and vice versa. As for those with ambiguous genitalia, the ruling depends on the predominance of male or female characteristics, as determined by doctors. A fatwa (definition) from the Permanent Committee has clarified that one must believe in and be content with Allah's decree. A person with ambiguous genitalia is either "non-problematic" (غير مشكل), in which case they are treated according to the predominance of male or female signs, with medical treatment being permissible to resolve the ambiguity, or they are "problematic" (مشكل), in which case they are treated with the stricter ruling in acts of worship and other matters.