In Eastern boundary upwelling systems, such as the California Current System (CCS), seasonal upwelling brings low oxygen and low pH waters to the continental shelf, causing ocean acidification and hypoxia (OAH). The location, frequency, and intensity of OAH events is influenced by a combination of large‐scale climatic trends, seasonal changes, small‐scale circulation, and local human activities. Here, we use results from two 20‐year long submesoscale‐resolving simulations of the Northern and Southern U.S. West Coast (USWC) for the 1997–2017 period, to describe the characteristics and drivers of OAH events. These simulations reveal the emergence of hotspots in which seasonal declines in oxygen and pH are accompanied by localized short‐term extremes in OAH. While OAH hotspots show substantial seasonal variability, significant intra‐seasonal fluctuations occur, reflecting the interaction between low‐ and high‐frequency forcings that shape OAH events. The mechanisms behind the seasonal decreases in pH and oxygen vary along the USWC. While remineralization remains the dominant force causing these declines throughout the coast, physical transport partially offsets these effects in Southern and Central California, but contributes to seasonal oxygen loss and acidification on the Northern Coast. Critically, the seasonal decline is not sufficient to predict the occurrence and duration of OAH extremes. Locally enhanced biogeochemical rates, including shallow benthic remineralization and rapid wind‐driven transport, shape the spatial and temporal patterns of coastal OAH. Plain Language Summary: As the global ocean undergoes significant oxygen depletion and acidification due to increasing anthropogenic pressures, coastal areas are increasingly exposed to stressful conditions for marine ecosystems. Eastern boundary upwelling systems, as the California Current System, are naturally vulnerable due to the seasonal on‐shelf transport of nutrient‐rich, oxygen‐poor, and acidic waters. In this study, we analyze a 20‐year high‐resolution numerical simulation of the southern and northern U.S. West Coast to describe the characteristics and drivers of ocean acidification and hypoxia events. These simulations reveal the emergence of hotspots characterized by significant increases in the frequency and duration of acidification or hypoxia events. While these locations show substantial seasonal variability, there is also significant intra‐seasonal variability, reflecting the interaction of low‐ and high‐frequency forcings that shape extreme events. Critically, the seasonal decrease is not sufficient to predict the occurrence and duration of extreme events. The influence of short‐term fluctuations in transport and remineralization rates is twofold, as they significantly increase the frequency and severity of extreme events, but also lead to shorter individual events. The resulting impacts on marine organisms are difficult to predict, as high‐frequency variability exacerbates potentially harmful conditions, but also causes periods of relaxation that may promote ecosystem resilience. Key Points: A 20‐year submesoscale‐permitting simulation describes acidification and hypoxia hotspots along the U.S. West Coast in spatio‐temporal detailPhysical transport mitigates seasonal oxygen and pH decline in Central California but promotes it along the northern coastShort‐term fluctuations in transport limit the duration of individual hypoxia and acidification events but exacerbate their intensity [ABSTRACT FROM AUTHOR]