[1] The album's title track became Accept's signature song and remains a metal anthem and trademark in the genre.

A controversy followed the American release, due to the record's title and front cover seen as homoerotic, and the lyrics to "London Leatherboys" and "Love Child" were interpreted to concern homosexuals.

In Europe it was never a big deal...we just wanted to be controversial and different and touch on these touchy subjects, because it gave us good press and it worked fabulously, you know".

"[5]The front cover image of the album bears a striking resemblance to photographer Robert Mapplethorpe's work "Patrice, N.Y.C."

[7] Dimebag Darrell of Pantera and Damageplan,[9][deprecated source] Doro Pesch of Warlock[10] and Kai Hansen of Helloween[11] were all fans of the band and consider Accept among their main musical influences.

The Swedish power metal band HammerFall said they recorded their album Renegade in 2000 with Michael Wagener because they had Balls to the Wall in mind.

[8] HammerFall also covered the song "Head Over Heels" with Accept's ex-lead vocalist, Udo Dirkschneider, on the 2008 album Masterpieces.

Canadian critic Martin Popoff liked the complexity of the lyrics combined with the clean and restrained riffing, which give the album "subtle sophistication" and a "singular purpose".