So this is of course polarizing and yes, Silva does have a tendency to deliberately shock for no dramatic purpose, but this film is carried by his muse Catalina Saavedra who helped him to stardom as "La Nana" (2009) which won Sundance back in the day. Silva then moved to the US and made one terrible film after another, all lacking the ingenious timing of "La Nana", so he has good reasons to be depressed and suicidal. This film is obviously a cleansing ritual of sorts, Silva kills himself to be born again, and while this may seem terribly self-centered, it does provide one of the most neglected actresses a chance to show her vast range.
It's also a rare satire of hedonistic queer life as only Almodóvar did before respectability killed his genius, also in collaboration with muses, most importantly Carmen Maura. It's no coincidence that Saavedra's part has similarities with Maura's in "What have I done to deserve this" (1984). Firstman is pretty gutsy doing a role like this (just imagine, Michael Cera turned it down). He is an Instagramer and this film makes you hate them even more. Most people don't seem to get the allegory of the artist working on film and canvas (which Saavedra destroys in her first scene) being replaced by the digital usurper, although that elevates the film to social criticism.
For me it's a positive surprise as I didn't expect much from it, but the shock value for non-gays makes it niche. To paraphrase a Latino saying, Americans just can't look cocks in the eye(s).