The stream rises in Great Gulf, a large glacial cirque on the northern side of Mount Washington. The West Branch flows from the outlet of Spaulding Lake, a tarn seated at the foot of the east face of Mount Clay, and proceeds northeast deeper into the gulf, with Mount Jefferson of the Presidential Range to the west and Chandlers Ridge, a northern spur of Mount Washington, to the east. Upon reaching the outlet of Jefferson Ravine, the river turns east, with Mount Adams and Mount Madison rising above its northern bank.