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The source of the Hoh River is meltwater from the Hoh Glacier on the northeast side of Mount Olympus. The river flows north then west, curving around the north side of the mountain. It collects headwater tributaries from other glaciers on Mount Olympus such as the Ice River, which flows from the Ice River Glacier, and Glacier Creek, which flows from Blue Glacier and White Glacier. Mount Tom Creek, a tributary which joins the Hoh farther downstream, flows from the White Glacier as well. Other headwater tributaries include Elkhorn Creek and Cream Lake Creek, both of which flow west from the Bailey Range of the Olympic Mountains. Ice River joins shortly below Cream Lake Creek. A few miles below that the Hoh River begins to flow more directly west. Glacier Creek joins from the south, from Mount Olympus. About a mile below Glacier Creek, at approximately Hoh river mile 48, the valley broadens and the river begins to take on braided characteristics. Falls Creek joins from the south, then Slate Creek and Hoh Creek from the north.
Olympus Ranger Station, a National Park Service cabin, is located on the north side of the river at approximately river mile 45, near the junction of the Hoh River Trail and the Hoh Lake Trail. At river mile 42 the Happy Four backcountry camping area is located along the river trail. Below that the tributary Cougar Creek joins from the north, then Mount Tom Creek from the south. Jackson Creek joins from the south at approximately river mile 37 near the Hoh Rain Forest Visitor Center and campground. The Visitor Center is located at the end of Upper Hoh Road and the beginning of the Hoh River Trail. The Upper Hoh Road runs east from U.S. Highway 101, paralleling the Hoh River from Willoughby Creek Campground to the national park. In the region near the national park boundary the Hoh River occupies a U-shaped valley with a flat bottom about one mile across. Mountain slopes rise steeply on either side.
The Hoh River continues flowing west, collecting numerous tributary streams, the most important being the South Fork Hoh River, which joins the main Hoh at about river mile 31. About a mile below the South Fork confluence the Hoh River leaves Olympic National Park. It continues to flow west through a widening valley surrounded by low mountains and foothills. Ranches occupy parts of the valley and land ownership is generally private. Owl Creek and Maple Creek join from the south. The Hoh makes a small northward bend, skirting the edge of, and briefly entering Olympic National Forest. Elk Creek joins from the south, then Alder Creek from the north, then Winfield Creek from the south, after which the Hoh River flows through a large horseshoe bend located at about river mile 15. Hell Roaring Creek joins the horseshoe bend from the north. Three campgrounds are sited along the river upstream from the horseshoe bend, including Minnie Peterson, Willoughby Creek, and Hoh Oxbow. All three are managed by Washington State Department of Natural Resources (DNR). Hoh Ox Bow Campground is located just west of the horseshoe bend near where U.S. Highway 101 crosses the river. Highway 101 follows the river on the south side. The small Oil City Road follows the Hoh River on the north side to the river's mouth. Cottonwood Campground, another DNR site, is on the north side of the Hoh River, accessed by Oil City Road.
Below the horseshoe bend the Hoh River begins to meander widely through a broad and flat floodplain. In its final miles the Hoh River collects the tributaries Fletcher Creek and Fossil Creek. Highway 101 leaves the river and heads south. About two miles from its mouth the Hoh River becomes the boundary between the Hoh Indian Reservation, on the south, and the coastal part of Olympic National Park on the north. The former settlement of Oil City is located on the north side of the Hoh River about a half mile from its mouth. A large headland peninsula called Hoh Head is located on the Pacific coast a few miles north of the river's mouth.
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