He is widely considered to be the most important openly gay twentieth-century Puerto Rican writer who wrote in Spanish, and his work was often controversial due to its sexual and political content.

He organized conferences and gatherings of his Puerto Rican writer friends in the United States such as Giannina Braschi and Luis Rafael Sanchez.

[4] Many but not all of Ramos Otero's works focus on autobiographical characters of gay Puerto Rican men who are writers and live in New York City.

Numerous literary scholars have written about Ramos Otero, including Arnaldo Cruz-Malavé, Jossianna Arroyo, Juan G. Gelpí, and José Quiroga.

[7][8] Rubén Ríos Ávila has compared Ramos Otero's experiences in New York to those of the exiled Cuban writer Reinaldo Arenas.

[9] Lawrence La Fountain-Stokes has written about Ramos Otero in the context of the Puerto Rican queer diaspora, comparing him to other artists such as Luz María Umpierre, Frances Negrón-Muntaner, Nemir Matos-Cintrón, and Erika Lopez.