Social determinants of health are the key to understanding and addressing disparities in adolescent pregnancy in the U.S. However, there is little guidance on what concrete steps organizations can take to work at the intersection of social determinants of health and sexual and reproductive health. Two community-based organizations completed a case study using a structured interview guide to illustrate their transition working at this intersection. The Alexandria Campaign on Adolescent Pregnancy and Identity, Inc. arrived at the intersection from opposite ends of the road. Despite clear differences in their trajectory, their experiences share four key elements that marked their success in expanding their core work: (a) both organizations enjoyed ample community and political support, (b) they used data to drive strategic decisions, (c) they used funding opportunities to move toward the intersection of sexual health and social determinants, and (d) they leveraged existing programs to sustain their efforts. Organizations working at the intersection must continuously leverage community, political, and financial capital to pursue partners, expand services, and change policies that sustain a holistic approach to youth health and well-being.